Method and apparatus for computerized surgery

ABSTRACT

An implant for use in spinal surgery comprises a resilient element having an inflatable cavity. It is formed of a biologically compatible material and is arranged for placement between end plates of adjacent vertebra. The implant may also include a wound disc replacement element. A method of performing signal surgery on a patient comprises securely mounting a patient onto a patient support table; imaging a spinal region of the patient; building up a three-dimensional image file of the spinal region of the patient; storing the image file; and utilizing the image file for planning and carrying out computer controlled spinal surgery on the patient utilizing the implant. A computer-controlled surgical implant system comprises a steerable endosurgical implanting operative to install the implant at a desired location in a patient; and a computerized controlled, which operates the steerable endosurgical implanting assembly.

This application is a divisional of U.S. Non-Provisional applicationSer. No. 09/948,940, filed on 7 Sep. 2001, now U.S. Pat No. 7,338,526,which claims benefit of 35 U.S.C. §119(e) of Israeli Patent ApplicationNos.: 128861, filed 7 Mar. 1999 and 128981, filed 14 Mar. 1999, thecontents of which are incorporated herewith by reference in theirentirety.

FIELD OF THE INVENTION

The present invention relates to the treat of spinal disorders generallyand more particularly to apparatus and techniques for treatment ofspinal disorders. The present invention may also have applicability toother types of surgery employing cannulae.

BACKGROUND OF THE INVENTION

There exist in the U.S. patent literature a substantial collection ofpatents relating to apparatus and techniques for treatment of spinaldisorders. The following U.S. patents are believed to represent thestate of the art: U.S. Pat. Nos. D377,527; D377096; D377,095; 5,772,661;5,766,254; 5,755,732; 5,741,261; 5,741,253; 5,735,899, 5,735,852;5,733,284; 5,730,706; 5,728,127; 5,728,098; 5,728,097; 5,725,582;5,720,751; 5,720,748; 5,718,877; 5,718,240; 5,716,415; 5,716,357;5,704,936; 5,702,455; 5,702,449; 5,702,395; 5,702,393; 5,700,292;5,700,291; 5,700,239; 5,697,929, 5,697,889; 5,690,629; 5,688,274;5,688,273; 5,688,272; 5,683,464; 5,683,390; 5,676,703; 5,676,701;5,676,665; 5,675,850; 5,674,296; 5,674,295; 5,672,175; 5,669,909;5,667,506; 5,665,122; 5,662,686; 5,658,335; 5,653,708; 5,651,789;5,649,945; 5,647,872; 5,645,598; 5,645,084; 5,643,329; 5,643,263;5,643,262; 5,643,260; 5,643,259; 5,634,925; 5,634,891; 5,630,816;5,630,802; 5,624,442; 5,624,441; 5,620,458; 5,618,315; 5,611,800;5,609,636; 5,609,635; 5,609,592; 5,599,287; 5,599,279, 5,593,409;5,593,407; 5,591,235; 5,591,165; 5,584,831; 5,571,102; 5,562,736;5,562,663; 5,562,662; 5,558,674; 5,556,428; 5,549,607; 5,545,166;5,545,163; 5,540,690, 5,536,268; 5,534,030; 5,534,002; 5;531;745,5,527,314; 5,522,899; 5,520,690, 5,520,687; 5,505,732; 5,499,983;5,498,263; 5,498,262; 5,498,233; 5,496,281; 5,489,308; 5,476,464;5,476,463; 5,476,462; 5,474,555; 5,454,551; 5,458,638; 5,454,812;5,443,514; 5,439,463; 5,437,669; 5,415,661; 5,415,659; 5,413,576;5,403,314; 5,390,683; 5,383,884; 5,363,841; 5,314,432; 5,306,309;5,306,307; 5,306,275; 5,282,862; 5,279,310, 5,267,999; 5,261,913;5,261,912; 5,261,910; 5,258,019, 5,209,751; 5,112,332; 5,090,758;5,059,193; 4,854,304; 4,836,196; 4,759,769; 4,714,469; 4,686,970;4,573,454; 4,445,513; 4,401,112; 4,085,744; 4,047,524; 4,041,939.

The current state of the art relating to lumbar disc surgery isdescribed in Current and Future Approaches to Lumbar Disc Surgery (ALiterature Review) By C. H. Alleyne Jr. and G. E. Rodts Jr. MedscapeOrthopedics & Sports Medicine which appears on the Internet onhttp://www.medscape.com/Medscape/OrthoSportsMed/1997/v01. n11;mos30518/07/98mos3, as well as in the references cited therein. Thedisclosures of all patent and literature references, mentioned in thisBackground of the Invention section, are hereby incorporated byreference.

SUMMARY OF THE INVENTION

The present invention seeks to provide improved apparatus and techniquesfor treatment of spinal disorders. The present invention also seeks toprovide apparatus and techniques for other types of surgical treatmentemploying cannulae.

According to a first aspect of the present invention there is providedan implant for use in spinal surgery comprising:

-   -   a resilient element having an inflatable cavity, the resilient        element being formed of a biologically compatible material and        being arranged for placement between end plates of adjacent        vertebra.

In an embodiment, the resilient element comprises an inflation valveoperatively associated with the inflatable cavity, which permitsinflation of the cavity to cause the resilient element to be in aninflated state and subsequent sealing of the cavity to retain theresilient element in the inflated state.

In a further embodiment the resilient element comprises an inflationconduit communicating with the inflation valve and extending outwardlythereof at least to a periphery of the end plates.

In yet a further embodiment the resilient element comprises a pluralityof lateral projections for engagement with a disc replacement coil.

In yet a further embodiment there is provided a disc replacement coillead wound about the resilient element.

According to a second aspect of the present invention there is providedan implant for use in spinal surgery comprising:

-   -   a disc replacement coil the disc replacement coil being formed        of a biologically compatible material and being arranged for        placement between end plates of adjacent vertebra.

A preferred embodiment also comprises a resilient element having aninflatable cavity, the resilient element being formed of a biologicallycompatible material and being arranged for placement between end platesof adjacent vertebra interiorly of the disc replacement coil.

In yet a further embodiment a seat element is seated in a recess formedin the resilient element, the seat element defining a generally circularinner recess, which defines a bearing race and retains therein aplurality of balls, thus defining a bearing.

In yet a further embodiment the seat element defines an outer recesswhich corresponds to the recess formed in the resilient element and alsodefines an outer flange which rests against a surface of the resilientelement.

In yet a further embodiment a circular sprocket is rotatably seated inthe outer recess of the seat element in bearing relationship with theballs in the bearing race.

In yet a further embodiment the circular sprocket includes an underlyingbearing race defining a circular recess, an inner circular array ofoutwardly facing teeth, which is engaged by a toothed drive belt and anouter circular array of outwardly facing teeth, each of which is formedwith a transverse recess.

In yet a further embodiment the outer circular array of outwardly facingteeth drivingly engages a correspondingly configured upstanding discreplacement coil for winding thereof.

In yet a further embodiment the sprocket also includes an overlyingbearing race defining a circular recess which retains therein aplurality of balls, thus defining a bearing.

In yet a further embodiment the resilient element comprises a slightlycurved generally planar, oval-shaped cover portion which corresponds inshape to a machined configuration of an adjacent facing plate of avertebra, for secure seating therein and optimized distribution ofpressure and forces thereon and shock absorbing.

In yet a further embodiment an outer surface of the cover portionincludes a slightly curved generally planar surface, first and secondelongate edge surfaces and a curved edge surface, the edge surfacesbeing joined together so as to define a continuous peripheral edgesurface and being joined with the planar surface in a generally seamlessmanner to define a smooth outer surface of the resilient element.

In yet a further embodiment the cover portion is formed with a generallycircularly ring-shaped bearing race, defining a recess at an innerfacing surface.

In yet a further embodiment there is provided a base member whichunderlies the resilient element and which corresponds in shape to amachined configuration of an adjacent facing plate of a vertebra, forsecure seating therein and optimized distribution of pressure and forcesthereon and shock absorbing.

In yet a further embodiment there is provided first and second generallyoval ring-shaped recesses formed in a surface of the resilient element.

In yet a further embodiment there is provided a rigid peripheral bandformed at peripheral surfaces of the resilient element and which issecured in a peripheral recess.

In yet a further embodiment there is provided a seat element having acircular array of bearing roller retaining recesses and correspondingcylindrical bearing rollers which are disposed on an inner surface of anouter recess and having a central recess, located interiorly of thecircular array of bearing roller retaining recesses.

In yet a further embodiment there is provided a second sprocket having amotor which provides rotation of outwardly facing teeth.

In yet a further embodiment the outwardly facing teeth are formed with atransverse recess.

In yet a further embodiment there is provided a base member which hasformed on an outer facing peripheral surface thereof a bearing racedefining an outer facing recess.

In yet a further embodiment the disc replacement coil comprises asprocket engagement belt having inwardly facing teeth arranged foroperative engagement with an outer circular array of outwardly facingteeth of a sprocket.

In yet a further embodiment the belt is assembled over the sprocket andis retained thereon by means of an inner facing peripheral protrusionwhich engages a transverse recess formed in the outwardly facing teeth.

In yet a further embodiment there is provided an upstanding coil windingportion extending from the engagement belt.

In yet a further embodiment the upstanding coil winding portion isformed with an extra thick portion which, when wound about the resilientelement, seats under the engagement belt.

In yet a further embodiment, the upstanding coil winding portion isformed with either or both of a fiber reinforcing layer and acompression wire.

In yet a further embodiment, the upstanding coil winding portion isformed with a varying thickness, whereby the thickness of the upstandingcoil when wound at various locations thereat corresponds to the desiredconfiguration of the resulting replacement disc.

In yet a further embodiment, the upstanding coil winding portion isformed with varying mechanical properties, whereby the characteristicsof the upstanding coil when wound at various locations thereatcorrespond to the desired characteristics of the resulting replacementdisc.

In yet a further embodiment, the upstanding coil winding portion iswound about the resilient element by rotation of the sprocket, causingthe upstanding coil winding portion to be tightly wound about theengagement belt and thus about the resilient element.

In yet a further embodiment, the upstanding coil winding portion isretained in a desired wound arrangement by means of engagement betweenone or more suitably disposed protrusions and corresponding socketsdisposed adjacent an outer end of the coil winding portion.

In yet a further embodiment, the upstanding coil winding portion isformed with a series of apertures or outwardly facing sockets which maybe engaged by an auxiliary coiling tool to assist in winding the coilwinding portion about the resilient element.

In yet a further embodiment, the upstanding disc replacement coilincludes a bearing race defining protrusion or recess retaining bearingballs therein, the protrusion or recess being located on a portion ofthe coil winding portion adjacent an engagement belt and positioned sothat upon winding thereof about the engagement belt, bearing ballsengage the bearing race.

In yet a further embodiment, the upstanding disc replacement coilincludes a bearing race defining protrusion or recess engaging bearingrollers, the protrusion or recess being located on a portion of the coilwinding portion adjacent an engagement belt and positioned so that uponwinding thereof about the engagement belt, bearing rollers engage thebearing race.

In yet a further embodiment, the upstanding disc replacement coilincludes a non flat cross-section along at least part of its length,wherein the coil winding portion terminates in a tail portion which isreadily separable therefrom by a perforation.

In yet a further embodiment, the non flat cross-section defines at leastone elongate recess on a first surface of a portion thereof and at leastone pair of matching elongate recesses on a second surface of theportion.

In yet a further embodiment the relative locations of the first andsecond surfaces are selected such that when the coil winding portion istightly wound about the resilient element, the recesses on the first andsecond surfaces face each other and together define an enclosed spacesuitable for insertion thereinto of a flowable elastomer.

In yet a further embodiment, a non-flat cross-section is located alongeither or both of the top and bottom edges of the upstanding discreplacement coil.

In yet a further embodiment, either or both of the top and bottom edgesare configured to at least partially lockingly engage with one or moreof the peripheral recesses formed by suitable machining of end plates ofvertebrae.

In yet a further embodiment, the peripheral recesses are formed with anundercut configuration and the cross-sections of at least one of the topand bottom edges are correspondingly configured.

In yet a further embodiment, the disc replacement coil comprisesmultiple turns of a generally flat coil element.

In yet a further embodiment, the end plates lie generally in parallelplanes and wherein the generally flat coil element lies generally inplanes parallel to the parallel planes of the end plates.

In yet a further embodiment, the generally flat coil element includesportions having convex rounded cross-sectional surfaces which are seatedin peripheral channels of respective ones of the end plates.

In yet a further embodiment, the generally flat coil element includesportions having undercut concave cross-sectional surfaces which faceperipheral channels of respective ones of the end plates and a flowablepolymer is inserted to fill interstices between adjacent coils at theconcave cross-sectional surfaces and at the peripheral channels.

In yet a further embodiment, the generally flat coil element includesportions having undercut convex cross-sectional surfaces which lockinglyseat in peripheral channels of respective ones of the end plates.

In yet a further embodiment, the generally flat coil element includes atleast one rib and at least one lip, which engage hook-like portions ofrespective ones of the coils.

In yet a further embodiment, the generally flat coil element includes atleast one flat disc replacement coil having formed thereon protrusionsseating in respective recesses formed thereon.

In yet a further embodiment, the generally flat coil element includes atleast one flat disc replacement coil which is held together byengagement elements.

In yet a further embodiment, the engagement elements lie in peripheralrecesses formed in the end plates and are retained therein by means of aflowable polymer.

In yet a further embodiment, the generally flat coil element includes adouble coil installed in situ between facing vertebrae.

In yet a further embodiment, the end plates lie generally in parallelplanes and wherein the generally flat coil element lies generallyperpendicular to the parallel planes of the end plates.

In yet a further embodiment, the resilient element comprises aninflation valve operatively associated with the inflatable cavity, whichpermits inflation of the cavity to cause the resilient element to be inan inflated state and subsequent sealing of the cavity to retain theresilient element in the inflated state.

In yet a further embodiment, the resilient element comprises aninflation conduit communicating with the inflation valve and extendingoutwardly thereof at least to a periphery of the end plates.

In yet a further embodiment, the resilient element comprises at leastone generally bandlike peripheral protrusion having peripheral edges.

In yet a further embodiment, the peripheral edges are undercut.

In yet a further embodiment, the at least one protrusion comprises twodiscrete protrusions.

In yet a further embodiment, there is provided an implant portion whichextends to the periphery of the end plates and enables injection of bodysubstances earlier removed from a nucleus pulposus to the region betweenthe end plates.

In yet a further embodiment, there is provided one or more discreplacement bands.

In yet a further embodiment, the disc replacement band has an overallconfiguration generally corresponding to a peripheral edge of theinflatable implant.

In yet a further embodiment, each disc replacement band is formed withan aperture on an outer facing side surface thereof, for engagement by atool.

In yet a further embodiment, each disc replacement band is formed withretaining sockets at an inner facing side surface thereof.

In yet a further embodiment, each disc replacement band is formed ofmechanically suitable, biologically compatible elastomer and includes afiber reinforcing layer and/or a compression wire.

In yet a further embodiment, each disc replacement band is a solid bandhaving respective top and bottom peripheral protrusions of generallypartially circular cross-section and inner and outer side surfaces whichare respectively concave and convex.

In yet a further embodiment, each disc replacement band is a solid bandhaving respective top and bottom peripheral protrusions of generallypartially circular cross-section and inner and outer side surfaces whichrespectively bear a peripheral undercut protrusion and a peripheralundercut socket, having undercut top and bottom edges.

In yet a further embodiment, each disc replacement band is a solid bandhaving respective top and bottom peripheral protrusions of generallypartially circular cross-section and inner and outer side surfaces, theinner side surface being formed with a peripheral undercut socket.

In yet a further embodiment, each disc replacement band is a solid bandhaving respective top and bottom peripheral protrusions of generallypartially circular cross-section and inner and outer side surfaces whichrespectively bear peripheral sockets, having undercut top and bottomedges.

In yet a further embodiment, each disc replacement band is a hollow bandhaving a void and having respective top and bottom peripheralprotrusions of generally partially circular cross-section and inner andouter side surfaces which are respectively concave and convex.

In yet a further embodiment, each disc replacement band includesrecesses formed at two facing inner side surface locations which areadapted to receive corresponding protrusions of the inflatable implant.

In yet a further embodiment, the recesses include a generally concaveinner side surface and a generally convex outer side surface,

In yet a further embodiment, the recesses are defined by a taperingsurface, which terminate at an inner surface.

In yet a further embodiment, each disc replacement band is formed withan aperture on an outer facing side surface thereof for engagement by atool.

In yet a further embodiment, each disc replacement band is formed withretaining sockets at an inner facing side surface thereof.

In yet a further embodiment, each disc replacement band is a solid bandhaving respective top and bottom peripheral protrusions of generallypartially circular cross-section.

In yet a further embodiment, each disc replacement band is formed of amechanically suitable, biologically compatible elastomer and includes atleast one of a fiber reinforcing layer and at least one compressionwire.

In yet a further embodiment, each disc replacement band is formed withtwo injection conduits for injection thereinto of a flowable polymer.

In yet a further embodiment, each disc replacement band is formed with agenerally U-shaped cross-section defining a slightly convex outer sidesurface and generally flat top and bottom surfaces, defining inwardlyfacing edges having a cross-sectional curvature which matches theconfiguration of peripheral edges of the inflatable implant.

In yet a further embodiment, each disc replacement band is configured attop and bottom surfaces thereof with apertures distributed along thecircumference of the band, whereby flowable polymers, injected intospaces between adjacent bands and between the inflatable implant and aband, flows outwardly through the apertures into undercut recesses inthe end plates.

In yet a further embodiment, each disc replacement band is configuredwith outer facing top and bottom corner edge recesses as well asapertures distributed along the circumference of its side surface.

In yet a further embodiment, each disc replacement band comprisesgenerally flat top and bottom surfaces defining inwardly facing edges.

In yet a further embodiment, the disc replacement coil comprises a maincoil portion including a plurality of coils having at least threediffering cross-sections and a tail portion which is removably connectedto the main coil portion.

In yet a further embodiment, the disc replacement coil comprises a headportion having a generally conical configuration and a lead coilportion, the head portion having a maximum cross-sectional dimensionwhich is slightly greater than the maximum cross-sectional dimension ofthe lead coil portion.

In yet a further embodiment, the disc replacement coil comprises a maincoil portion including a plurality of coils at least one of which havinga first generally omega-shaped cross-section.

In yet a further embodiment, the first generally omega-shapedcross-section comprises a central region including a convex roundedcross-sectional surface which corresponds to a cross-sectionalconfiguration of a channel formed in an end plate and a concave roundedcross-sectional surface.

In yet a further embodiment, the plurality of coils includes at leastone coil having a generally rectangular cross-section and a centralrounded protrusion at the center thereof, defining a plurality of convexrounded cross-sectional surfaces at least one of which being configuredto seat in the concave rounded surface.

In yet a further embodiment, the plurality of coils includes at leastone coil having a second generally omega-shaped cross-section.

In yet a further embodiment, the second generally omega-shapedcross-section is a mirror-image of the first generally omega-shapedcross-section.

In yet a further embodiment, the plurality of coils includes at leastone coil having a third generally omega-shaped cross-section, identicalto the second generally omega-shaped cross-section.

In yet a further embodiment, the plurality of coils includes at leastone coil which includes at an inner facing edge thereof a hook-likeportion which is configured to lockingly engage a lip and a rib of aninflatable implant.

In yet a further embodiment, the plurality of coils includes at leastone coil which is formed with a transverse recess which permits accessto an inflation valve.

In yet a further embodiment, the plurality of coils includes at leastone coil having inner facing edges formed to define channels which areconfigured to lockingly engage corresponding surfaces of a protrusion ofan inflatable implant.

In yet a further embodiment, the disc replacement coil comprises aconnector coupled to a main coil portion via a perforated junction.

In yet a further embodiment, the connector is configured and adapted tobe readily mechanically coupled to an engagement socket of a coiled leadof an inflatable implant.

In yet a further embodiment, the disc replacement coil is formed withundercut recesses on each of respective top and bottom surfaces thereof.

In yet a further embodiment, the recesses extend substantially along theentire length of the coil.

In yet a further embodiment, the disc replacement coil is formed with agenerally rectangular cross-section having a first hook-like portion atan inner, bottom facing corner thereof and having a second hook-likeportion at an outer, top facing corner thereof.

In yet a further embodiment the disc replacement coil is formed with agenerally rectangular cross-section having a central slanted recess at atop facing surface thereof.

In yet a further embodiment, the disc replacement coil is formed with agenerally rectangular cross-section having two differing widths alongits length defining a corrugated configuration.

In yet a further embodiment, the disc replacement coil is formed withteeth and corresponding recesses which do not extend over the entirewidth of the coil and thus serve to mutually align the individual coilsin three dimensions.

In yet a further embodiment, the disc replacement coil is formed withopposing engagement elements of two different types which are designedfor secure engagement therebetween.

According to a third aspect of the present invention there is providedan implant for use in spinal surgery comprising:

-   -   a disc replacement band assembly, the disc replacement band        assembly being formed of a biologically compatible material and        being arranged for placement between end plates of adjacent        vertebra.

In an embodiment, there is further provided a resilient element havingan inflatable cavity, the resilient element being formed of abiologically compatible material and being arranged for placementbetween end plates of adjacent vertebra interiorly of the discreplacement band assembly.

In yet a further embodiment, the disc replacement band assemblycomprises at least one generally flat band element.

In yet a further embodiment, the end plates lie generally in parallelplanes and the at least one generally flat band element lies generallyperpendicular to the parallel planes of the end plates.

In yet a further embodiment, the resilient element comprises aninflation valve operatively associated with the inflatable cavity, whichpermits inflation of the cavity to cause the resilient element to be inan inflated state and allows subsequent sealing of the cavity to retainthe resilient element in the inflated state.

In yet a further embodiment, the resilient element comprises aninflation conduit communicating with the inflation valve and extendingoutwardly thereof at least to a periphery of the end plates.

According to a fourth embodiment of the present invention there isprovided an implant for use in spinal surgery comprising:

-   -   a wound disc replacement element, the wound disc element being        formed of a biologically compatible material and being arranged        for placement between end plates of adjacent vertebra.

In yet a further embodiment, the wound disc replacement elementcomprises a wound filament.

In yet a further embodiment, the wound disc replacement elementcomprises a wound strip.

In yet a further embodiment, a resilient element has an inflatablecavity, is preferably formed of a biologically compatible material andis preferably arranged for placement between end plates of adjacentvertebra interiorly of a disc replacement coil.

In yet a further embodiment, the resilient element comprises aninflation valve operatively associated with the inflatable cavity, whichpermits inflation of the cavity to cause the resilient element to be inan inflated state and allows subsequent sealing of the cavity to retainthe resilient element in the inflated state.

In yet a further embodiment, the resilient element comprises aninflation conduit communicating with the inflation valve and extendingoutwardly thereof at least to a periphery of the end plates.

In yet a further embodiment, the resilient element comprises a pair ofgenerally planar surfaces and a peripheral edge surface, which areconfigured to correspond to the configuration of a corresponding recessformed in at least one end plate for secure seating therein,optimization of distribution of pressure and forces thereon and shockabsorbing.

In yet a further embodiment, the resilient element also comprises amulti-coil spiral outwardly extending rib located on the peripheral edgesurface.

In yet a further embodiment, the resilient element also comprises a lipformed onto the multi-coil spiral outwardly extending rib for providingenhanced locking engagement of a disc replacement implant with theresilient element.

In yet a further embodiment, the resilient element also comprises aprotrusion formed onto the multi-coil spiral outwardly extending rib forproviding enhanced locking engagement of a disc replacement implant withthe resilient element.

A yet further embodiment comprises a lead coiled about the resilientelement along the multi-coil spiral outwardly extending rib.

In yet a fitter embodiment, the lead is formed with engagement elementsat opposite ends thereof, one of such engagement elements being adaptedto be attached to a forward end of a flat disc replacement coil, anotherone of such engagement elements being adapted to be hooked onto by asuitable pulling tool.

In yet a further embodiment, the disc replacement coil comprises a head,a lead coil portion, a main coil portion and a tail portion.

In yet a further embodiment, the main coil portion comprises, at aninner facing edge thereof, a hook-like portion which is configured tolockingly engage the resilient element.

In yet a further embodiment, the main coil portion is formed with atleast one undercut recess on at least one surface thereof, the recessextending along the length of the main coil portion.

In yet a further embodiment, the main coil portion is also formed withat least one undercut protrusion on a surface thereof, the protrusionextending along the length of the main coil portion and being configuredfor locking engagement with the at least one undercut recess.

In yet a further embodiment, the main coil portion is formed with afirst hooking portion on a surface thereof, the first hooking portionextending along the length of the main coil portion.

In yet a further embodiment, the main coil portion is also formed with asecond hooking portion on a surface thereof the second hooking portionextending along the length of the main coil portion and being configuredfor locking engagement with the first hooking portion.

In yet a further embodiment, at least a portion of the disc replacementcoil has a generally rectangular cross-section having toothed oppositefacing surfaces.

In yet a further embodiment, the toothed opposite facing surfaces do notextend over the entire width of the coil and thus serve to mutuallyalign overlapping portions of the coil in three dimensions.

In yet a further embodiment, at least a portion of the disc replacementcoil is formed with opposite facing hook-type mutually engagingsurfaces.

A yet further embodiment, has an overall wedge shaped configuration.

According to a fifth aspect of the present invention there is provided amethod of performing spinal surgery on a patient comprising:

-   -   securely mounting a patient onto a patient support table;    -   imaging a spinal region of the patient;    -   building up a three dimensional image file of the spinal region        of the patient;    -   storing the image file;    -   utilizing the image file for planning and carrying out computer        controlled spinal surgery on the patient.

In an embodiment, there is further provided the step of planning andvisualizing a computer controlled surgical approach path, in order tomaximize avoidance of vital organs, nerves and blood vessels.

In a further embodiment, the utilizing step employs patient data storedin a computer memory as well as imaging data derived from earlierpatient imaging and reference medical data, and

the reference medical data includes medical imaging informationcurrently available on computer networks.

In yet a further embodiment, the imaging step comprises determining adesired patient orientation for pre-operative imaging and performingcomputer simulated imaging based on the desired patient orientation.

In yet a further embodiment, the securely mounting step includesorienting the support table by downloading data indicating a desiredpatient orientation from a computer.

In yet a further embodiment, patient imaging is supplemented in a regionof interest with medical reference data and composite images areprovided, characterized in that patient imaging data is clearlydistinguished from overlaid reference data.

In yet a further embodiment there are provided the steps of

-   -   determining a navigation path of a first cannula subassembly in        three spatial dimensions and over time; and    -   determining an anchoring location for the first cannula        subassembly.

In yet a further embodiment, there is provided a second cannulasubassembly, and there are further provided the steps of:

-   -   determining the pathway and timing of the insertion of a third        cannula subassembly over first and second cannula subassemblies;        and    -   determining an intended anchoring location for the third cannula        subassembly.

In yet a further embodiment, the utilizing step comprises:

-   -   determining the timing of removal from the body of the patient        of a first cannula subassembly, a second cannula subassembly and        an inner portion of a third cannula subassembly; and    -   determining the timing and technique to be used for suctioning        of a disc.

In yet a further embodiment, the utilizing step comprises:

-   -   planning restoration of end plates of vertebrae utilizing        surgical vehicles and milling tools.

In yet a further embodiment, the restoration includes an initial millingstage defining a recess for a generally “bean shaped” inflatable pillow.

In yet a further embodiment, the restoration also comprises defining atleast one channel in the end plate.

In yet a further embodiment, there is provided the step of planninginsertion of an inflatable implant in a recess formed in at least oneend plate.

In yet a further embodiment, the restoration comprises insertion of atop surface plate following suitable machining of the top surface of anend plate.

In yet a further embodiment, the restoration comprises providing arecess encompassing a buckled portion of an end plate for receiving abone graft and inserting a bone graft in the recess.

In yet a further embodiment, the restoration comprises providingtreatment for scoliosis by providing a seat and a channel for securelyreceiving a bone graft and inserting a bone graft at the seat and thechannel with precise dimensions corresponding to those of the seat andthe channel such that a portion of the bone graft protrudes from a topsurface of the end plate.

In yet a further embodiment, there is provided the step of planninginsertion of an inflatable implant between end plates of adjacentvertebra by employing tools including an inflation tool in associationwith a surgical vehicle.

In yet a further embodiment, there is provided the step of planninginsertion of a disc replacement implant surrounding the inflatableimplant.

In yet a further embodiment, the disc replacement implant comprises aflat disc replacement coil.

In yet a further embodiment, the disc replacement implant comprises anupstanding disc replacement coil.

In yet a further embodiment, the utilizing step comprises carrying out asimulated operation on a computer in an off-line manner.

In yet a further embodiment, the step of carrying out a simulatedoperation employs stored patient image data and is linked to theintended configuration of the implant and its operating environment.

In yet a further embodiment, during the step of carrying out a simulatedoperation, the surgeon modifies at least one aspect of a plannedoperation.

A yet further embodiment includes applying computerized analysis to thesimulated operation.

A yet further embodiment includes providing computer generated commentsand warnings to an operator based on the computerized analysis.

In yet a further embodiment, there is provided the additional step ofplanning disc suctioning.

In yet a further embodiment, the step of utilizing the image file forplanning and carrying out computer controlled spinal surgery on thepatient, comprises the steps of:

-   -   extracting a cannula entry position from a final real time        starting operation plan;    -   positioning the patient as required; and    -   inserting the first cannula subassembly into the patient in        accordance with the final real time starting operation plan as        modified interactively in real time by the surgeon.

In yet a further embodiment, the step of inserting the first cannulasubassembly into the patient comprises the steps of:

-   -   initiating penetration of the first cannula subassembly into the        patient; and    -   using the final real time starting operation plan as modified        interactively in real time by the surgeon, causing a desired        sequence of coordinated movements of the first cannula        subassembly, the coordinated movements including one or more of        linear forward motions of the first cannula subassembly,        rotation of the first cannula subassembly and curvature control        of the first cannula subassembly.

In yet a further embodiment, the step of causing a desired sequence ofcoordinated movements of the first cannula subassembly is effected byprovision of synchronized instructions to a controller for operation ofat least one motor and at least one piston of a steering subassembly.

In yet a further embodiment, the step of causing a desired sequence ofcoordinated movements of the first cannula subassembly is effected byemploying real-time imaging.

In yet a further embodiment, the provision of synchronized instructionsis terminated upon engagement of the first cannula subassembly with adisc.

In yet a further embodiment, the engagement of the first cannulasubassembly with a disc is evidenced at least partially by real-timeimaging.

In yet a further embodiment, there is provided a step of anchoring ofthe first cannula subassembly into the disc at an anchoring location.

Preferably, the step of anchoring the first cannula subassembly into thedisc at an anchoring location comprises rotational threaded engagementof an anchoring screw of the first cannula subassembly into the disc.

In yet a further embodiment, there is provided a step of sliding thesecond cannula subassembly over the first cannula subassembly.

Preferably, the sliding step takes place after the steering subassemblyis removed from the first cannula subassembly.

In yet a further embodiment, the sliding step comprises the followingsteps:

-   -   inserting the second cannula subassembly along the outside of        the first cannula subassembly, under initiation by the surgeon;    -   providing a desired sequence of movements of the second cannula        subassembly, derived from the final real time starting operation        plan as modified interactively in real time by the surgeon;    -   providing linear forward motion of the second cannula        subassembly, using a motor in response to inputs supplied        thereto by a controller;    -   when the second cannula subassembly reaches the disc turning off        the motor by the controller; and    -   thereafter, locking the second cannula subassembly into        engagement with the first cannula subassembly.

In yet a further embodiment, there is provided a step of sliding thethird cannula subassembly over the second cannula subassembly.

In yet a further embodiment, the step of sliding the third cannulasubassembly takes place in accordance with a final real time operationplan as modified interactively in real time by the surgeon.

In yet a further embodiment, a step of sliding the third cannulasubassembly comprises the following steps:

-   -   inserting the third cannula subassembly along the outside of the        second cannula subassembly under initiation by the surgeon;    -   providing a desired sequence of movements of the third cannula        subassembly, which sequence is derived from the final real time        starting operation plan as modified interactively in real time        by the surgeon;    -   providing linear forward motion of the third cannula        subassembly, using a motor in response to inputs supplied        thereto by a controller; and    -   turning off the motor from the controller when an intended        target location of the third cannula subassembly is reached.

In yet a further embodiment, the step of sliding the third cannulasubassembly employs at least one blade disposed adjacent a forward edgeof the third cannula subassembly.

In yet a further embodiment, the step of sliding the third cannulasubassembly also includes location corrections to the locations of thefirst and second cannula subassemblies.

In yet a further embodiment, the location corrections are achieved bymodifying a curvature of the third cannula subassembly through use of asteering subassembly.

In yet a further embodiment, the step of modifying the curvature of thethird cannula subassembly through use of a steering subassembly isachieved using real time high accuracy imaging information.

In yet a further embodiment, a step is preferably provided of couplingthe third cannula subassembly to the second cannula subassembly.

In yet a further embodiment, following locking of an inner portion ofthe third cannula subassembly to the second cannula subassembly, anouter portion of the third cannula subassembly is decoupled from aninner portion thereof.

In yet a further embodiment, following decoupling of the outer portionand the inner portion of the third cannula subassembly, a controlleroperates a motor to move the outer portion forward relative to the innerportion until the forward edge of the outer portion engages vertebrae.

In yet a further embodiment, following engagement of the outer portionwith the vertebrae, anchoring screws threadably engage a vertebra, thusanchoring the outer portion of the third cannula subassembly to thevertebra.

In yet a fixer embodiment, the steps are provided of withdrawal of thefirst and second cannula subassemblies and the inner portion of thethird cannula subassembly through the outer portion of the third cannulasubassembly.

In yet a further embodiment, there is provided a step of discsuctioning.

In yet a further embodiment, there is provided a step of vertebraemachining.

In yet a further embodiment, there is provided a step of discimplantation.

In yet a further embodiment, there is provided a step of vertebra endplate reconstruction.

In yet a further embodiment, the step of vertebrae machining includes aninitial milling stage defining a recess for an implant.

In yet a further embodiment, the initial milling stage defines a recessfor a generally “bean shaped” inflatable pillow as well as a network ofchannels including a plurality of generally radially directed channelsand a peripheral channel.

In yet a further embodiment, in the initial milling stage, a generallycentral region of a top surface of an end plate is milled to provide agenerally smooth milled surface having a recess formed generally at thecenter thereof.

In yet a further embodiment, the step of vertebra end platereconstruction includes the steps of employing a surgical vehicle, ahand and a pair of forceps tools to insert, position and spread out areinforcing fabric over a machined surface of an end plate.

In yet a further embodiment, reinforcing fabric is impregnated with anadhesive which is activated in situ.

In yet a further embodiment, the reinforcing fabric is adhered using afluid adhesive.

In yet a further embodiment, the step of vertebra end platereconstruction includes the steps of machining of a top surface of anend plate and subsequent insertion and placement thereover of at leastone top surface plate.

In yet a further embodiment, at least one top surface plate isimpregnated with an adhesive which is activated in situ.

In yet a further embodiment, at least one top face plate is adheredusing a fluid adhesive.

In yet a further embodiment, the at least one top face plate is adheredto the vertebra by fasteners.

In yet a further embodiment, the step of vertebra end platereconstruction includes the steps of employing a surgical vehicle, ahand and a pair of forceps tools to insert, position and adhere a bonegraft in engagement with a machined surface of an end plate.

In yet a further embodiment, the step of machining of a top surface ofan end plate comprises using a surgical vehicle, a hand and a millinghead to provide a generally smooth milled sure having a recess formedgenerally at the center thereof.

In yet a further embodiment, the step of machining of a top surface ofan end plate comprises using a surgical vehicle, a hand and a millinghead to provide a generally smooth milled surface having a channel and arecess formed generally at the center thereof.

In yet a further embodiment, the step of machining of a top surface ofan end plate comprises using a surgical vehicle, a hand and a millinghead to provide a generally smooth milled surface having a channel and agenerally oval recess formed generally at the center thereof as anextension of the channel.

In yet a further embodiment, the step of machining of a top surface ofan end plate also comprises using a surgical vehicle, a hand and amilling head to provide a peripheral channel surrounding the recess.

In yet a further embodiment, the step of machining of a top surface ofan end plate also comprises using a surgical vehicle, a hand and amilling head to provide a nearly peripheral channel, having ends whichextend to an edge of the end plate.

In yet a further embodiment, the peripheral channel surrounding therecess has a generally semicircular cross-sectional configuration.

In yet a further embodiment, the peripheral channel surrounding therecess has a keystone undercut cross-sectional configuration.

According to a sixth aspect of the present invention there is provided amethod of treating scoliosis comprising vertebra end platereconstruction and including the steps of employing a surgical vehicle,a hand and a pair of forceps tools to insert a bone graft intoengagement with a machined surface of a vertebra end plate.

In an embodiment, the bone graft is in the form of a wedge which isattached at a seat and secured in a channel machined into the vertebraend plate.

Preferably, following attachment of the bone graft, a top surface of thebone graft is machined to be flush with the remainder of the top surfaceof the end plate.

A yet further embodiment, includes insertion of a fusion implantincluding at least one bone graft.

In yet a further embodiment, the fission implant comprises at least onebone graft enclosed in an enclosure made of a biologically compatiblematerial and being arranged for placement between end plates of adjacentvertebra.

In yet a further embodiment, the fusion implant comprises a plurality ofbone graft segments, each preferably enclosed in an enclosure made of abiologically compatible material the plurality of segments preferablybeing together enclosed in an enclosure made of a biologicallycompatible material.

According to a seventh aspect of the present invention there is provideda method for performing spinal surgery comprising the steps of insertionand inflation of an inflatable implant between facing end plates ofadjacent vertebrae.

In an embodiment, the insertion and inflation employs a plurality ofsurgical vehicles, a plurality of hands and a plurality of tools.

A further embodiment also comprises application of traction to thevertebrae in a controlled manner.

In yet a further embodiment, there are also provided one or more of endplate reconstructions, reinforcement and machining, prior to insertionof the inflatable implant.

In yet a further embodiment, insertion of the inflatable implant betweenthe end plates employs a pair of pick and place tools, each mounted on asurgical vehicle via a hand, as well as an inflation tool, mounted on asurgical vehicle via a hand.

In yet a further embodiment, the inflatable implant, upon insertionthereof between the end plates, is partially deflated and issubsequently inflated, thereby to cause expansion of the implant.

In yet a further embodiment, a gauging tool is used for measuring one orboth of the extent of inflation of the inflatable implant and theresulting separation between adjacent vertebrae.

In yet a further embodiment marks are placed on at least one of theinflatable implant and adjacent vertebrae to enable the orientationthereof to be sensed.

In yet a further embodiment, information is derived from either or bothof a gauging tool and marks planed on either or both of the inflatableimplant and adjacent vertebrae to a computer for either or both ofconfirmation and interactive modification of a final real time startingoperation plan.

In yet a further embodiment, the inflatable implant comprises agenerally bean-shaped inflatable portion and a protruding inflationconduit, which enables selectable inflation and deflation of theinflatable implant without interference from other implants subsequentlyinserted surrounding the inflatable implant.

According to an eighth aspect of the present invention there is provideda method for performing spinal surgery comprising the steps ofinsertion, between facing end plates of adjacent vertebrae, of a flatdisc replacement coil.

In an embodiment, the insertion employs a flat disc replacement coiltransporter and dispenser.

In a further embodiment, insertion also employs at least one surgicalvehicle, at least one hand and at least one tool.

In yet a further embodiment, a surgical vehicle is located alongside theflat disc replacement coil transporter and dispenser and has a handmounted thereon.

In yet a further embodiment, a coil forceps tool is mounted on the handwhich is in turn mounted on the surgical vehicle.

In yet a further embodiment, forward and intermediate coil drivingassemblies of the flat disc replacement coil transporter and dispenserare operated to push a lead coil portion of the flat disc replacementcoil forwardly relative to the transporter and dispenser.

In yet a further embodiment, due to its pre-coiled configuration, thelead coil portion tends to coil about the inflatable implant.

In yet a further embodiment, a forceps tool engages a coil head of thelead coil portion using finger pairs and a guiding finger for pullingthe coil head and assisting in coiling of the lead coil portion aboutthe inflatable implant.

In yet a further embodiment, at the stage of coiling of the lead coilportion about the inflatable implant a main coil portion of the discreplacement coil mainly remains coiled in a storage bay in the flat discreplacement cod transporter and dispenser, the forward part of the mainportion extending forwardly of the storage bay, following the lead coilportion, which is engaged by at least one of intermediate and forwardcoil driving assemblies of the flat disc replacement coil transporterand dispenser.

In yet a further embodiment, during continued coiling of the lead coilportion about the inflatable implant, a tool is gradually repositionedso as to guide the lead coil portion for producing a desired coilconfiguration.

In yet a further embodiment, during continued coiling of the lead coilportion about the inflatable implant, a coil forceps tool engages thelead coil portion and the coil head using finger pairs and a guidingfinger for pulling the coil head and the lead coil portion and assistingin continued coiling of the lead coil portion about the inflatableimplant.

In yet a further embodiment, the main coil portion extends forwardly ofthe storage bay through a coil feeder, following the lead coil portion,and through an intermediate coil driving assembly.

In yet a further embodiment, during continued coiling of the lead coilportion about the inflatable implant, a tool is employed in order toprovide a flowable bonding material to the main coil portion as it isbeing coiled about the inflatable implant.

In yet a further embodiment, a coil forceps tool engages and pulls acoil head rearwardly, thus assisting in coiling of a main coil portionabout the inflatable implant.

In yet a further embodiment, the main coil portion extends through theentire extent of the coil transporter and dispenser via at least onecoil feeder and at least one of intermediate and forward coil drivingassemblies.

In yet a further embodiment, following coiling of the lead coil portionabout the inflatable implant, the coil head and most of the lead coilportion are retracted into a third cannula subassembly.

In yet a further embodiment, a laser cutting tool is employed forcutting a tail portion from a coiled main coil portion of a discreplacement coil.

In yet a further embodiment, the laser cutting tool is also employed forcutting the lead coil portion from the coiled main coil portion.

In yet a further embodiment, following coiling of the main coil portionabout the inflatable implant, the inflatable implant is slightlydeflated.

In yet a further embodiment, the flat disc replacement coil is aleadless flat disc replacement coil.

According to a ninth aspect of the present invention there is provided amethod for performing spinal surgery comprising the steps of insertionand inflation of an integrated inflatable implant and pre-coiled leadbetween facing end plates of adjacent vertebrae.

Preferably, the insertion step employs a flat disc replacement coiltransporter and dispenser having a pair of hands mounted on quickconnection mounting assemblies thereof.

Preferably, initially, in the insertion step, while the flat discreplacement coil transporter and dispenser lies outside an outer portionof a third cannula subassembly, connectors of a leadless coil in thecoil transporter and dispenser are manually connected to engagementsockets of the pre-coiled lead.

In an embodiment, following the manual connection, the flat discreplacement coil transporter and dispenser is inserted into and proceedsthrough the third cannula subassembly to a location adjacent vertebrae.

In a further embodiment, the flat disc replacement coil transporter anddispenser is driven by one or more surgical vehicles docked thereto,while a winch takes up slack in the pre-coiled lead.

In yet a further embodiment, during positioning of the flat discreplacement coil transporter and dispenser adjacent vertebrae, a tool,mounted via a hand onto a surgical vehicle, may be employed to engagethe pre-coiled lead for maintaining a desired orientation thereof.

In yet a further embodiment, the tool is operative to engage and thusdirect a main coil portion of the coil for proper desired coilingthereof about the inflatable implant.

In yet a further embodiment, during the insertion, a connector of thecoil and an engagement socket of the coiled lead are drawn inwardlytowards a winch, while a corresponding length of a main coil portion ofthe coil is played out.

In yet a further embodiment, at a second stage in the insertion of theflat disc replacement coil, continued coiling of the main coil portiontakes place about the inflatable implant.

In yet a further embodiment, at a third stage in the insertion of theflat disc replacement coil, when a cable and a lead coil portion havebeen wound on a winch, a laser cutting tool is employed for cutting atail portion from a coiled main coil portion.

In yet a further embodiment, the laser cutting tool is also employed forcutting a connector from the main coil portion.

In yet a further embodiment, following coiling of the main coil portionabout the inflatable implant, the inflatable implant is slightlydeflated.

According to a tenth aspect of the present invention, there is provideda method for performing spinal surgery comprising the step of winding afilament between facing end plates of adjacent vertebrae, thereby toprovide a disc replacement coil.

An embodiment, preferably includes the step of inserting between thefacing end plates an inflatable implant assembly.

In a further embodiment, the step of inserting the inflatable implantassembly includes inserting an inflatable implant assembly having acircular implant portion such that an engagement belt of a woundfilament disc replacement coil assembly engages teeth of a sprocket, anda driving belt, being drivingly coupled to a disc replacementtransporter and engaging teeth of a sprocket thereon is inserted betweenthe end plates.

In yet a further embodiment, the step of inserting employs an inflationtool which is premounted onto the implant assembly and is operativelycoupled thereto via a valve.

In yet a further embodiment, the implant portion of the inflatableimplant assembly, upon initial insertion thereof between the end platesis somewhat deflated and is subsequently inflated by means of theinflation tool.

In yet a further embodiment, a gauging tool is employed for measuringthe extent of inflation of at least one of the implant portion and theresulting separation between adjacent vertebrae.

In yet a further embodiment, a sensor is employed for measuring theextent of inflation of at least one of the implant portion and theresulting separation between adjacent vertebrae.

In yet a further embodiment the measured extent of inflation of eitheror both of the implant portion and the resulting separation betweenadjacent vertebrae is supplied to a computer for one or more ofconfirmation purposes and interactive modification of a final real timestarting operation plant.

In yet a further embodiment, the step of inserting the inflatableimplant assembly between the facing end plates comprises a first stagewherein, when the inflatable implant assembly is located betweenadjacent vertebrae, the inflatable implant assembly is suitably inflatedand when a disc replacement transporter and dispenser is located betweenadjacent vertebrae, a lead portion already having been wound about theinflatable implant portion, a tool is employed to engage a filament fordesired positioning of the filament as it is wound about the inflatableimplant portion.

In yet a further embodiment, a dispenser tool is used in order toprovide flowable bonding material to the wound filament coiled about theinflatable implant portion.

In yet a further embodiment, the step of inserting the inflatableimplant assembly between the facing end plates also comprises a secondstage wherein winding of the filament takes place in a manner such thatfilament crossovers occur generally in a desired given region, which maybe identified in planning and carrying out the operation by reference toa system of polar coordinates.

In yet a further embodiment, the step of inserting the inflatableimplant assembly between the facing end plates also comprises a stagewherein winding of the filament takes place in a manner such thatfilament crossovers occur generally in multiple regions, which may beidentified in planning and carrying out the operation.

In yet a further embodiment, by selecting a number and location of thecrossovers about the inflatable implant, the configuration of the woundfilament disc replacement is determined.

In yet a further embodiment, by selecting number, type and location ofvariations in cross-section of a filament winding portion, theconfiguration of the wound filament disc replacement is determined.

In yet a further embodiment, there is provided the step of selecting anumber of filament coils at various distances along the separationbetween adjacent vertebrae.

In yet a further embodiment, filament coils are located withincorresponding undercut recesses machined into at least one end path thusproviding a desired interconnection therewith.

In yet a further embodiment, the filament coils include biomaterials.

In yet a further embodiment, following completion of end platereconstruction and reinforcement and suitable end plate machining, aninflatable implant assembly which includes an engagement belt of anupstanding disc replacement coil, engaging teeth of a sprocket and adriving belt, the driving belt being drivingly coupled to an upstandingdisc replacement coil transporter and dispenser and engaging teeth of asprocket therein, is inserted between end plates of respective adjacentvertebra.

In yet a further embodiment, the insertion employs at least one toolmounted on a surgical vehicle via a hand.

In yet a further embodiment, a tool is used which is mounted on theupstanding disc replacement coil transporter and dispenser via a handand positioned between the engagement belt and the coil portion.

In yet a further embodiment, the upstanding disc replacement coiltransporter and dispenser contains a coil in an orientation ready forwinding as well as a driving belt in an orientation ready for drivingthe sprocket of an implant assembly.

In yet a further embodiment, an inflation tool is premounted onto theimplant assembly and is operatively coupled thereto via a valve.

In yet a further embodiment, when the inflatable implant assembly islocated between adjacent vertebrae and is suitably inflated and when theupstanding disc replacement coil transporter and dispenser is locatedadjacent the vertebrae, a tool mounted via a hand onto the upstandingdisc replacement coil transporter and dispenser, is employed to engagethe upstanding coil winding portion of the coil, the tool beingpositioned adjacent the vertebrae.

In yet a further embodiment, another tool, mounted via a secondhand ontoa second surgical vehicle, is operative to assist in winding the coilwinding portion.

In yet a further embodiment, a dispenser tool is employed in order toprovide a flowable bonding material to the coil winding portion as it isbeing coiled about the inflatable implant portion.

In yet a further embodiment, when the inflatable implant assembly islocated between adjacent vertebrae, a motor drives the driving belt indriving engagement with the sprocket, causing the engagement belt towind the coil winding portion about the engagement belt and about theinflatable implant portion and during this winding procedure, forwardand rearward coil driving assemblies of the coil transporter anddispenser push the coil winding portion, thus participating in thewinding thereof.

In yet a further embodiment, coordination between the operation of themotor and operation of the coil driving assemblies governs the tightnessof the wound coil.

In yet a further embodiment, a laser cutting tool is employed forcutting a tail portion from a coiled main coil portion.

In yet a further embodiment, the laser cutting tool is also employed forcutting a connector from the main coil portion.

In yet a further embodiment, following coiling of the main coil portionabout the inflatable implant, the inflatable implant is slightlydeflated.

In yet a further embodiment, the flat disc replacement coil is insertedby the following steps:

-   -   inflation of an inflatable implant located between adjacent        vertebra end plates, and    -   slidingly inserting tools between the adjacent vertebra end        plates, the tools including flexible battens having edge        protrusions which lie in channels formed in the end plates.

In yet a further embodiment, the inflatable implant is thereafterslightly deflated, to an extent that the outer dimensions of the implantare decreased, thereby tightly engaging battens between the end plates,increasing the space between the implant and the battens, while theimplant is still retained in an immobilized state between the endplates.

In yet a finer embodiment, an inflatable implant is located betweenadjacent vertebrae and is inflated; an upstanding disc replacement coiltransporter and dispenser is located adjacent vertebrae; at least onetool including a flexible batten is employed to engage an upstandingcoil winding portion of a coil supplied by the disc replacement coiltransporter and dispenser and to assist in coiling it about theinflatable implant; and a dispenser tool is employed in order to providea flowable bonding material to the coil winding portion as it is beingcoiled about the inflatable implant.

In yet a further embodiment, the upstanding disc replacement coil ispushed by forward and rearward coil driving assemblies of the discreplacement coil transporter and dispenser into winding engagementaround the implant.

In yet a further embodiment, the upstanding disc replacement coil ispushed by forward and rearward coil driving assemblies of the discreplacement coil transporter and dispenser into winding engagementaround the implant by causing a tip of the coil to slide along an innersurface of an enclosure defined by at least one batten.

In yet a further embodiment, an additional tool is used to push or pullthe coil winding portion, by engagement with at least one socket formedthereon, thus at least partially governing the tightness of the woundcoil.

In yet a further embodiment, the coil winding portion adjacent the tipis engaged by a concave surface of a tool to contain the coil windingportion within the enclosure and thus to cause it to form a second coiltherewithin.

In yet a further embodiment, following coiling of the coil windingportion about the inflatable implant and further inflation thereof, thecoil winding portion is locked in tightly wound engagement with theinflatable implant and the battens are slidably disengaged from therecesses.

In yet a further embodiment, tightening of the coil winding portionabout the inflatable implant produces engagement of ribs on the implantinto corresponding recesses on the coil winding portion.

In yet a further embodiment, there is provided deflation of theinflatable implant following disengagement of the battens.

According to an eleventh aspect of the present invention there isprovided a method for insertion of an implant between end plates ofrespective adjacent vertebra comprising the steps of:

-   -   employing a pair of pick and place tools, each mounted on a        surgical vehicle via a hand, to insert an inflatable implant        between the end plates, the inflatable implant being partially        deflated upon insertion thereof between the end plates;    -   employing an inflation tool which is pre-attached to an outward        end of a conduit in communication with a valve forming part of        the inflatable implant to inflate the inflatable implant, thus        causing expansion of the inflatable implant;    -   following inflation of the inflatable implant to a required        extent slidingly inserting batten bearing tools between adjacent        end plates by means of forceps tools, such that edge protrusions        of battens thereof lie in channels of respective end plates.    -   thereafter, slightly deflating the inflatable implant, to an        extent that the outer dimensions of the implant are decreased        thereby tightly engaging the battens between respective end        plates, thereby increasing the space between the inflatable        implant and the battens, while the implant is still retained in        an immobilized state between the end plates;    -   deflating the inflatable implant;    -   removing the inflatable implant from between respective end        plates; and    -   inserting at least one disc replacement band between facing end        plates of adjacent vertebrae, following removal of the        inflatable implant.

Preferably, the step of inserting comprises introducing at least oneouter band between the facing end plates while the at least one outerband is initially retained in a narrowed configuration.

In an embodiment the step of inserting comprises introducing at leastone inner band between the facing end plates following insertion of theat least one outer band and while the at least one inner band isinitially retained in a narrowed configuration.

According to a twelfth aspect of the present invention there is provideda method for insertion of an implant between end plates of respectiveadjacent vertebra comprising the steps of:

-   -   inserting an inflatable implant in a folded orientation and at        least one disc replacement band coupled thereto between the end        plates, the inflatable implant being partially deflated upon        insertion thereof between the end plates; and    -   employing an inflation tool to inflate the inflatable implant,        thus causing expansion of the inflatable implant.

Preferably, prior to insertion of an inflatable implant in a foldedorientation and one or more disc replacement bands coupled theretobetween the end plates, there are provided the steps of:

-   -   inserting an inflatable implant between the end plates, the        inflatable implant being partially deflated upon insertion        thereof between the end plates;    -   employing an inflation tool which is pre-attached to an outward        end of a conduit in communication with a valve forming part of        the inflatable implant to inflate the inflatable implant, thus        causing expansion of the inflatable implant;    -   following inflation of the inflatable implant to a required        extent, slidingly inserting batten bearing tools between        adjacent end plates by means of forceps tools, such that edge        protrusions of battens thereof lie in channels of respective end        plates.    -   thereafter, slightly deflating the inflatable implant, to an        extent that the outer dimensions of the implant are decreased        thereby tightly engaging the battens between respective end        plates, thereby increasing the space between the inflatable        implant and the battens, while the implant is still retained in        an immobilized state between the end plates;    -   deflating the inflatable implant; and    -   removing the inflatable implant from between respective end        plates.

In an embodiment, the disc replacement band comprises a single band.

In a further embodiment, the disc replacement band comprises two bandswhich are tightly held together by inflation of the inflatable implant.

In yet a further embodiment, the disc replacement band comprises twobands having mutually interlocking portions which are caused tolockingly engage by inflation of the inflatable implant.

In yet a further embodiment, the disc replacement band comprises twobands having mutually interlocking portions, the inflatable implant alsoincludes an interlocking portion and the two bands and the inflatableimplant are caused to lockingly engage by inflation of the inflatableimplant.

In yet a further embodiment, a flowable polymer is introduced into avolume defined at least between portions of the at least one discreplacement band adjacent surfaces of the end plates and is operative,once set, to lock the portions of the at least one disc replacement bandtogether in flexible engagement.

In yet a further embodiment, locking engagement of portions of the atleast one disc replacement band is provided by press fit engagementbetween inwardly facing edges of the at least one disc replacement bandand corner edge recesses thereof.

In yet a further embodiment, a flowable polymer is introduced into avolume defined at least by channels having an undercut cross-sectionalconfiguration and being formed in the end plates, such that once set,the flowable polymer attaches the at least one disc replacement band tothe end plates in flexible engagement.

In yet a further embodiment, an intermediate band is formed in situ froma flowable polymer in a volume defined at least between inner surfacesof the at least one disc replacement band.

In yet, a further embodiment, an intermediate band is formed in situfrom a flowable polymer in a volume defined at least in peripheralchannels, having a undercut cross-sectional configuration, which areformed in the end plates, whereby the flowable polymer locks the atleast one disc replacement band to the end plates in flexible engagementand the intermediate band retains the inflatable implant in positionwith the disc replacement band in surrounding engagement therewith.

In yet a further embodiment, the at least one disc replacement bandcomprises at least two hollow bands and preferably, body material fromthe nucleus pulposus is introduced under pressure to a volumeintermediate adjacent end plates.

According to a thirteenth aspect of the present invention there isprovided a method for performing spinal fusion comprising:

-   -   initially milling and machining at least one end plate of        adjacent vertebrae to provide at least one generally straight        channel extending from one edge of the end plate to a location        adjacent an opposite edge thereof; and    -   inserting and placing a bone graft on at least one machined        surface of at least one of the end plates in engagement with the        channel.

Preferably, the method is carried out using the techniques ofendosurgery.

Preferably, the inserting and placing step includes enclosing a bonegraft segment within a fiber sleeve, thereby providing a honeycombstructure.

According to a fourteenth aspect of the present invention there isprovided a computer-controlled surgical implant system comprising:

-   -   at least one steerable endosurgical implanting assembly        operative to install an implant at a desired location in a        patient; and    -   a computerized controller operating the at least one steerable        endosurgical implanting assembly.

In yet a further embodiment, the at least one steerable endosurgicalassembly comprises a multi-stage cannula assembly.

In yet a further embodiment, the at least one steerable endosurgicalassembly comprises a multi-functional cannula assembly.

In yet a further embodiment, a tracking system is preferably providedfor tracking the position of the endosurgical implanting assembly.

In yet a further embodiment, the at least one steerable endosurgicalimplanting assembly presides an anchoring functionality for anchoring acannula at a desired location.

In yet a further embodiment, there is provided a computer controlledpatient support table, which preferably comprises:

-   -   a chest support portion;    -   a plurality of intermediate support elements, selectably        positionable with respect to a longitudinal axis of the chest        support portion to accommodate an existing or desired        orientation of the patient; and    -   a lower body support portion having a longitudinal axis, which        is angled with respect to the chest support portion by an angle,        selected to accommodate an existing or desired orientation of        the patient.

In yet a further embodiment, there is provided an equipment support basearranged to be mounted over the back of the patient onto the supporttable.

In yet a further embodiment, there are provided encoders to enableaccurate patient repositioning on the patient support table.

In yet a further embodiment, the at least one steerable endosurgicalimplanting assembly operative to install an implant at a desiredlocation in a patient comprises a multifunctional surgical assemblyincluding:

-   -   a universal mounting assembly which is secured to and supported        by the equipment support base;    -   at least two drive assemblies, which are replaceably and        modularly mountable onto the universal mounting assembly; and    -   a multifunctional cannula assembly, operative in association        with the universal mounting assembly and with the at least two        drive assemblies.

In yet a further embodiment, the multifunctional cannula assemblyincludes at least two different cannula subassemblies which are drivenby respective ones of the at least two drive assemblies.

In yet a further embodiment, the multifunctional surgical assemblyincludes a computerized operator interface.

In yet a further embodiment, the universal mounting assembly comprises:

-   -   first mounting tracks which are removably attached to the        equipment support base;    -   a carriage assembly, defining second mounting tracks and        arranged for selectable and fixable positioning on the first        mounting tracks;    -   a platform, arranged for selectable and fixable positioning onto        the second mounting tracks; and    -   a cannula mounting assembly associated with the platform and        onto which are mounted the first, second and third drive        assemblies.

In yet a further embodiment, there is provided a real-time imagingassembly mounted onto the platform.

In yet a further embodiment, there is also provided an array of RFreceiving antennas which are used for sensing the precise orientationand position of elements of the multifunctional cannula subassembly.

In yet a further embodiment, the cannula mounting assembly comprises:

-   -   a base which is mounted onto the platform, the base including an        upstanding portion and a protruding portion;    -   a spherical bearing mounted onto the protruding portion and        including a central aperture through which first, second and        third cannula subassemblies, which form part of the        multifunctional cannula assembly, may slidably extend;    -   a selectably orientatable socket mounted on the spherical        bearing for removably and replaceably receiving the first,        second and third drive assemblies.

In yet a further embodiment, the selectably orientatable socket isselectably positionable in three dimensions by at least two pivotablymounted positioning pistons operated by a hydraulic driving controller.

In yet a further embodiment, the at least two pivotably mountedpositioning pistons are pivotably mounted onto a portion of the base bymeans of spherical mounting bearings and are attached to the socket bymeans of spherical mounting bearings.

Preferably there are also provided first, second and third driveassemblies, each of which comprises a housing onto which is mounted alinear driving motor controlled by a linear driving controller, and arotational driving motor controlled by a rotational driving controller.

Preferably, each linear driving motor is coupled to at least one drivingroller, which drivingly engages a cannula subassembly for providinglinear driving thereof and wherein each rotational driving motor iscoupled to gearing which drivingly engages the cannula subassembly forproviding rotational driving thereof.

Preferably there is also provided a pressurized fluid source having aplurality of pressurized fluid sockets mounted on the cannula mountingassembly.

In yet a further embodiment, there is also provided a multifunctionalcontroller which includes a plurality of electric power sockets and aplurality of electric control signal sockets, the multifunctionalcontroller receiving electric control and power inputs from an operatorinterface.

In yet a further embodiment there is also provided a bi-directionalinformation link between the multifunctional controller and variousdevices controlled thereby, such that at any given time, the controlleris aware of the identity and operational status of each of the devicescontrolled thereby, for optimal control of the operation thereof.

In yet a further embodiment, the multifunctional cannula assemblycomprises first, second and third cannula subassemblies, which aregenerally coaxial.

In yet a further embodiment, the first cannula subassembly is steerableto a desired location in a patients anatomy.

In yet a further embodiment, the first cannula subassembly comprises acentral flexible core located within a flexible outer tube, the outertube containing therewithin curvature control tendons which may betensioned or compressed to effect desired curvature of the first cannulasubassembly.

In yet a further embodiment, the first cannula subassembly alsocomprises a flexible shaft terminating in a anchor screw, and at leastone fiber optics link.

In yet a further embodiment, the first cannula subassembly alsocomprises a cover for the anchor screw which is formed of a materialwhich is readily absorbed by the human body.

In yet a further embodiment, the shaft is rotatably located within abore formed within the core.

In yet a further embodiment there are also provided tendons which areslidably disposed within respective elongate bores formed in the core.

In yet a further embodiment, the tendons are each anchored at a locationadjacent a forward end of the first cannula subassembly and coupled atan opposite end thereof to a driving structure.

In yet a further embodiment, the driving structure is formed withexternally facing recesses to enable it to be readily engaged by anexternal driving member for linear driving thereof in a push-pull mannerfor applying tension or compression to the tendon fixed thereto.

In yet a further embodiment, the driving structure is linearly slidablydisposed in a recess formed in the core at a window formed in the outertube.

In yet a further embodiment there is also provided at least one fiberoptics link located in a suitable recess or bore formed in the core andextending to at least one optical sensor.

In yet a further embodiment there is also provided at least one fiberoptics link located in a suitable recess or bore formed in the core andextending from an light source to an illuminator.

In yet a further embodiment, the first cannula subassembly alsocomprises at least one electrical conductor for supplying electricalpower to at least one electrical signal beacon transducer which issensible by at least one of the elements of a real time imagingassembly, thereby to enable the precise location and orientation of thefirst cannula subassembly to be ascertained and monitored.

In yet a further embodiment, the first cannula subassembly alsocomprises an elongate low power RF transmitting antenna receiving anelectrical signal from a suitable RF signal source such that its preciseorientation may be readily sensed by antennas forming part of a realtime imaging assembly.

In yet a further embodiment, the first cannula subassembly alsocomprises an elongate recess formed along a majority of the length ofthe first cannula subassembly, the recess being engageable by a suitableprotrusion connected to gearing for rotational driving of the firstcannula subassembly.

In yet a further embodiment, the second cannula subassembly is arrangedto be inserted over the first cannula subassembly and has a lagercross-section than the first cannula subassembly.

In yet a further embodiment, the second cannula subassembly comprises aplurality of sub-sub-assemblies, each of larger cross-section than itspredecessor.

In yet a further embodiment, the second cannula subassembly includes aconditioned easily grippable surface for enhancing ease of manipulationof the second cannula subassembly.

In yet a further embodiment, the second cannula subassembly includesfiber optics connectors at the rearward end of the second cannulasubassembly for fiber optics communication connections between fiberoptics links, which communicate with optical sensor, and illuminators.

In yet a further embodiment, the second cannula subassembly includes,adjacent a rearward end thereof a slider, having a manual engagementportion, and a generally flat portion, having a forward end, the sliderbeing slidably retained in the second cannula subassembly forlongitudinal sliding motion relative thereto, into and out of operativeengagement with a flexible engagement member.

In yet a further embodiment, the flexible engagement member is formed ofa resilient material and includes a mounting portion which is seated ina recess formed in the second cannula subassembly, an elongate portionand an inner facing proton portion, the flexible engagement member beingmounted such that it is biased inwardly into engagement into a recess inthe first cannula subassembly, when not displaced by the slider.

In yet a further embodiment, the third cannula subassembly comprisestrack for transport of surgical equipment therealong to a surgical sitein the patient's anatomy and removal of body materials from the surgicalsite.

In yet a further embodiment, the third cannula subassembly comprises atleast one electrical power link; and at least one fiber optics link.

In yet a further embodiment, the third cannula subassembly comprisespiping for liquid transport, vacuum and gas pressure.

In yet a further embodiment, the third cannula subassembly also includesa plurality of curvature control tendons.

In yet a further embodiment there is also provided, in association withthe first cannula subassembly, a steering subassembly comprising ahousing onto which are mounted a drill driving assembly and a tendontensioning and compressing assembly; and a base which is mounted on thehousing and which supports a fiber optic connector assembly.

In yet a further embodiment, the tendon tensioning and compressingassembly comprises a plurality of pistons, corresponding in number tothe number of tendons in the first cannula subassembly, each of thepistons operative for selectably tensioning or compressing an individualtendon.

In yet a further embodiment, each of the plurality of pistons includesan at least partially flexible toothed shaft which is arranged tooperatively engage recesses in driving structures for producing lineardisplacement thereof in recesses formed in the core for selectablytensioning or compressing individual tendons attached to each of thedriving structures.

In yet a further embodiment, the third cannula subassembly comprises aninner portion; and an outer portion, the outer portion being selectablyslidable with respect to the inner portion and comprising a generallycylindrical hollow element formed with a plurality of tracks.

In yet a further embodiment, the plurality of tacks include a firstplurality of inner facing tracks having a first cross-sectionalconfiguration and a second plurality of inner facing tracks, having across-sectional configuration different from that of the first pluralityof tracks.

In yet a further embodiment, the plurality of tracks include a thirdplurality of inner facing tracks having a cross-sectional configurationdifferent from that of the first and second pluralities of tracks andalso having an undercut cross-section.

In yet a further embodiment, the outer portion comprises at least oneelongate bore having disposed therein an anchoring screw including atapered thread at a forward end and an engagement head at a rearwardend.

In yet a further embodiment, the outer portion comprises, disposed inthe at least one elongate bore, an elongate eye assembly, the elongateeye assembly including a visual sensor and an illuminator.

In yet a further embodiment, the visual sensor is coupled, via a fiberoptic link embedded in an elongate eye manipulating support, toutilization circuitry.

In yet a further embodiment, the manipulating support is, in turn,operated by a drive assembly mounted on the outer portion, and by an eyedirecting assembly and is capable of linear displacement and rotationrelative to the outer portion as wen as directable bending.

In yet a further embodiment there are also provided tendons disposed inbores formed in the outer portion, the tendons being employable forproviding selectable bendability and directability to the third cannulasubassembly.

In yet a further embodiment, the inner portion functions principally asa spacer for properly positioning the outer portion with respect to thesecond cannula subassembly and is designed to be removed prior tocarrying out most of the functionality of the outer portion.

In yet a further embodiment, fiber optics connectors are provided at therearward end of the third cannula subassembly for fiber opticscommunication between fiber optics links which communicate with opticalsensors and illuminators.

In yet a further embodiment there is also provided a slider disposedadjacent a rearward end of the third cannula subassembly, the sliderhaving a manual engagement portion and a generally flat portion, theflat portion having a forward end, the slider being slidably retained inthird cannula subassembly for longitudinal sliding motion relativethereto, into and out of operative engagement with a flexible engagementmember.

In yet a further embodiment, the flexible engagement member is formed ofa resilient material and includes a mounting portion which is seat in arecess formed the inner portion, an elongate portion and an inner facingprotrusion portion, the flexible engagement member being mounted suchthat it is biased inwardly into engagement with a recess in the secondcannula subassembly, when not displaced by the slider.

In yet a further embodiment there is also provided a locking pin,associated with the outer portion, which selectably engages a recessformed in the inner portion for preventing linear motion therebetweenprior to intended removal of the inner portion from the outer portion.

In yet a further embodiment, the drive assembly comprises a housing ontowhich is mounted a linear driving motor which is controlled by a lineardriving controller, the driving motor being coupled to at least onedriving roller, which drivingly engages eye manipulating support.

In yet a further embodiment, the drive assembly also comprises arotational driving motor, which is controlled by a rotational drivingcontroller, the rotational driving motor being coupled to gearing, whichdrivingly engages the eye manipulating support for providing rotationaldriving thereof.

In yet a further embodiment, the eye dic assembly comprises a housingonto which is mounted a tendon tensioning and compressing assembly andhas an output which is coupled to an operator visualization subsystem.

In yet a further embodiment, the elongate eye assembly includes aplurality of visual sensors surrounding an illuminator.

In yet a further embodiment there is also provided at least oneself-propelled surgical vehicle associated with their cannulasubassembly.

In yet a further embodiment, the at least one self-propelled surgicalvehicle comprises a body of generally uniform cross-section having alongitudinal bore and defining forward and rearward faces; at least twofreely rolling rollers mounted on the body; and a driving roller, whichis powered by an electric motor, disposed within the body.

In yet a further embodiment, the at least one self-propelled surgicalvehicle comprises a quick connection mounting assembly located at atleast one of the forward and rearward faces at the bore.

In yet a further embodiment, the forward face of the body is formed witha plurality of recesses which are employed for assisting in the mountingof hands onto the vehicle.

In yet a further embodiment, the body is formed with a pair oflongitudinal recesses which extend along edges of the body in parallelto the bore and in which are disposed the at least two freely rollingrollers.

In yet a further embodiment, the driving roller is disposed in one ofthe pair of longitudinal recesses.

In yet a further embodiment, the at least two freely rotating rollersroll along at least one track formed in the third cannula subassemblyand the driving roller drivingly engages cogs formed along at leastanother track formed in the third cannula subassembly for precisionlongitudinal positioning of the vehicle along the tracks.

In yet a further embodiment, the electric motor is controlled by amultifunctional controller via a control cable which extends through theouter portion of the third cannula subassembly.

In yet a further embodiment, the electric motor receives electricalpower from the multifunctional controller via a power cable extendingfrom an electric power socket which is removably coupled to a socketformed on the rearward face.

In yet a further embodiment, auxiliary electrical power is provided forhands attached to the forward face by means of an auxiliary power cablewhich is removably coupled to a socket formed on the rearward face andextends through the longitudinal bore.

In yet a further embodiment, auxiliary electrical control is providedfor hands attached to the forward face by means of an auxiliary controlcable which is removably coupled to a socket formed on the rearward faceand which extends through the longitudinal bore.

In yet a further embodiment, auxiliary electrical control is provided tothe socket for the hands attached to the forward face by means of anauxiliary control cable which is removably coupled to a socket formed onthe rearward face, extends through the outer portion of the thirdcannula subassembly and is connected to a control signal socket of amultifunctional controller.

In yet a further embodiment, the vehicle has cross-sectional dimensionswhich do not exceed 20 mm.

In yet a further embodiment, the body is formed with a throughgoing borefor accommodating an eye manipulating support.

In yet a further embodiment, the body is formed with a pair oflongitudinal recesses which extend along edges of the body in parallelto the bore and in which are disposed the at least two freely rollingrollers and a third longitudinal recess along which are disposed atleast one freely rolling roller and a driving roller, which is poweredby an electric motor disposed within the body.

In yet a further embodiment, the third longitudinal recess is formed atits ends with a cross-sectional configuration defining an undercut whichmaintains operating engagement between the at least one freely rollingroller, the driving roller and the track and thus enables the vehicle toride on the single track.

In yet a further embodiment, the at least one freely rolling rollerrolls along the track, while the driving roller drivingly engages cogson the track for precision longitudinal positioning of the vehicletherealong.

In yet a further embodiment, the vehicle has cross-sectional dimensionswhich do not exceed 16 mm.

In yet a further embodiment, the body is formed with a longitudinalrecess defining forward and rearward faces onto which are formed quickconnectors, peripherally of the recess and wherein at least one freelyrolling roller and a driving roller, powered by an electric motor aredisposed within the body.

Alternatively, the longitudinal recess is formed at its ends with across-sectional configuration defining an undercut which maintainsoperative engagement between the at least one freely rolling roller andthe driving roller and the track and thus enables the vehicle to ride onthe single track.

In yet a further embodiment, the at least one freely rolling rollerrolls along the track, while the driving roller drivingly engages cogson the track for precision longitudinal positioning of the vehicletherealong.

In yet a further embodiment, the vehicle has cross-sectional dimensionswhich do not exceed 10 mm.

In yet a further embodiment there is also provided at least one nonself-propelled surgical vehicle.

In yet a further embodiment, the at least one non self-propelledsurgical vehicle comprises an elongate flexible element having a forwardface and a rearward face and a generally uniform cross-sectionalconfiguration including an undercut which maintains operative engagementbetween the vehicle and a track on the third cannula subassembly.

In yet a further embodiment, the at least one non self-propelledsurgical vehicle is translated along tracks of the third cannulasubassembly by an electric motor external of the vehicle.

In yet a further embodiment, a quick connector is provided on at leastone elongate surface of each vehicle for connection thereto of hands.

In yet a further embodiment there is also provided a universal handwhich is employed in association with the at least one surgical vehicle,the universal hand including a base, which is removably coupled to asurgical vehicle; a first intermediate element rotatable relative to thebase about a longitudinal axis in the base by an electric motor, asecond intermediate element rotatable relative to the first intermediateelement by an electric motor, at least one additional intermediateelement rotatable relative to the second intermediate element by anelectric motor, and a tool engagement element rotatable relative to theat least one additional intermediate element by an electric motor.

In yet a further embodiment, the at least one additional intermediateelement comprises at least first and second additional intermediateelements, which are rotatable relative to each other.

In yet a further embodiment, a plurality of the vehicles issimultaneously operated with a plurality of hands.

In yet a further embodiment, four of the vehicles and four hands aresimultaneously employed.

In yet a further embodiment there is also provided at least one toolmounted on the tool engagement element.

In yet a further embodiment, the at least one tool is selected from thefollowing tools: a milling head, a forceps tool, a forceps finger, anfluid disperse tool, a pick and place tool, an articulated element, aninflation tool, a gauging tool, and a cutting tool.

In yet a further embodiment there is also provided a staging assemblyemployable in setting up and connecting tools and hands together withsurgical vehicles, the staging assembly comprising a pair of end mounts,which are fixedly joined together by an elongate base element, whichdefines an inner facing surgical vehicle support track which isalignable with a track in the third cannula subassembly, the end mountsdefining seats for removably and securably receiving respective innerfacing surgical vehicle support track defining members which arealignable with tracks in the third cannula subassembly.

In yet a further embodiment there is also provided a staging complexcomprising a plurality of staging assemblies and being operative formodularly connect various pieces of surgical equipment together andmounting them onto surgical vehicles.

In yet a further embodiment, one or more staging assemblies comprise apair of end mounts, fixedly joined together by an elongate base elementwhich defines an inner facing surgical vehicle support track, whichtrack is alignable with a track in the third cannula subassembly, theend mounts defining seats for removably and securably receivingrespective inner facing surgical vehicle support track defining memberswhich are alienable with track in the third cannula subassembly.

In yet a further embodiment, the end mounts are of generally openoctagonal configuration and are fixedly joined together by an elongatebase element, which defines an inner facing surgical vehicle supporttack, which is alignable with a track in the third cannula subassembly.

In yet a further embodiment, the end mounts each define seats forremovably and securably receiving inner facing surgical vehicle supporttrack defining members.

In yet a further embodiment, retaining pins are provided for removableengagement with sockets formed in at least one of the end mounts forengagement with corresponding sockets formed in ends of support trackdefining members, thereby to ream the track defining members inengagement with their respective seats.

In yet a further embodiment, one of the end mounts is provided with aninner socket which is configured to receive a flange of the outerportion of the third cannula subassembly in such a manner that thevehicle support track defining members of the staging assembly areproperly aligned with the respective inner facing tracks of the outerportion.

In yet a further embodiment, the socket and the corresponding flange areformed to have somewhat angled walls thereby to provide designed mutualmating thereof.

In yet a further embodiment there is also provided a retaining pinengaging a socket in an end mount and a corresponding socket in acorresponding flange, thereby to retain the flange in mating engagementwith the socket.

In yet a further embodiment, surgical vehicles, hands and tools aremounted onto a track defining member prior to attachment of the trackdefining member onto the end mounts.

In yet a further embodiment, the computerized controller also comprisesan operator interface comprising an operator support seat assembly, anda plurality of control elements, arranged in an arc so as to be readilyengageable by an operator seated on the seat assembly, the plurality ofcontrol elements including visualization rotation control elements; atleast one visualization zoom control element, forward and rearward driveelements and a brake element, useful for governing operation of firstsecond and third cannula subassemblies, surgical vehicles and handsassociated therewith.

In yet a further embodiment, the operator interface also comprises adisplay coupled to a computer which contains at least patient imagingdata and operation planning data; and a least one computer input device.

In yet a further embodiment, the operator interface also comprisesvirtual reality apparatus.

In yet a further embodiment the operator interface comprises: anoperator visualization subsystem; and an operator-controlled drivingsubsystem the operator-controlled driving subsystem and the operatorvisualization subsystem being operative together.

In yet a further embodiment, the operator visualization subsystemreceives inputs from at least three of the following elements: acomputer, a real time imaging assembly, optical sensors, a keyboard, amouse, a joystick and a hand interface.

In yet a further embodiment, the operator visualization subsystemprovides outputs to at least one of illuminators, monitors and virtualreality equipment.

In yet a further embodiment, the operator-controlled driving subsystemis operable to interactively interface with the operator visualizationsubsystem and also to receive inputs from at least one of the followingelements: a computer, control pedals; a keyboard; a mouse; a joystick; ahand interface; audio inputs from a headset and hand and toolidentification and orientation inputs from a multifunctional controller.

In yet a further embodiment, the operator-controlled driving subsystemprovides outputs to controllers.

In yet a further embodiment, the operator support seat assemblycomprises a fixed base, selectably vertically raisable and lowerable legportions having leg portions fixedly attached thereto, a back and headsupport a seat, which is swivelable in a generally horizontal planeabout a vertical axis and adjustably fixable arm supports.

In yet a further embodiment there is also provided a plurality of footcontrol pedals which are arranged about a vertical axis so as to bereadily engageable by an operator seated on the seat who swivels theseat appropriately, the plurality of foot control pedals includingclockwise and counterclockwise visualization rotation control pedals avisualization zoom control pedal, forward and rearward dive pedals and abrake pedal, the foot control pedals being operative to governtranslation of the first, second and third cannula subassemblies, andthe surgical vehicles.

In yet a further embodiment, the viral reality apparatus is operable toprovide to an operator a sense that his hands are located within aregion between adjacent vertebra at which the operation is taking placeand are able to accurately manipulate various hands, within that region.

In yet a further embodiment, the virtual reality apparatus is operableto provide to an operator a view of the patients spine having nonecessary relationship with the actual orientation of the patient'sspine.

According to a fifteenth aspect of the invention there is provided atool for use in association with a hand and comprising:

-   -   a quick connection mounting assembly for connection to a hand;        and    -   a pair of elements, having respective inwardly facing surfaces        which are configured to correspond to the cross-sectional        configuration of a main portion of a coil.

According to a sixteenth aspect of the present invention there isprovided a tool for use in association with a hand and comprising:

-   -   a quick connection mounting assembly for connection to a hand;    -   a pair of elements having respective inwardly facing surfaces        which are configured to define a coil coating passage having a        cross-section corresponding to the cross-sectional configuration        of the main portion of a coil;    -   a liquid coating supply conduit, which communicates with outlet        orifices, formed on at least one coil surface for supplying a        liquid coating material to a coil as the coil passes        therethrough.

In an embodiment, the liquid coating material is an in situpolymerizable polymer which, when polymerized, becomes an elastomericbond substance.

In a further embodiment, the liquid coating material is a flowablepolyurethane.

According to a seventeenth aspect of the present invention there isprovided a tool for use in association with a hand and comprising:

-   -   a quick connection mounting assembly for connection to a hand;    -   a base onto which is fixedly mounted a first forceps finger pair        and a guiding finger; and    -   a second forceps finger pair, mounted for selectable positioning        with respect to the first forceps finger pair.

According to an eighteenth aspect of the present invention there isprovided a tool for use in association with a hand and comprising:

-   -   a quick connection mounting assembly for connection to a hand;        and    -   a laser couplable to an energy outlet by means of an optical        fiber assembly.

According to a nineteenth aspect of the present invention there isprovided a tool for use in association with a hand and comprising:

-   -   a rigid element defining an inner facing channel on a concave        suds thereof which matches a cross-sectional configuration of a        coiled lead of an inflatable implant, for placement of the        implant in a recess, without disturbing the arrangement of the        coils of the coiled lead.

According to a twentieth aspect of the present invention there isprovided a coil winding assistance tool for use with a hand andcomprising:

-   -   a base;    -   an arm attached at an end thereof to the base;    -   an outwardly extending finger and a transversely extending thumb        disposed at an end of the arm, opposite to the end of the arm        which is attached to the base, the finger and the thumb being        configured to cooperate with a socket on a coil for assisting in        the winding thereof.

According to a twenty-first aspect of the present invention there isprovided an inflator tool for use with a hand and comprising:

-   -   an output nozzle; and    -   a flexible fluid supply tube for receiving a pressurized fluid        input from a pressurized fluid source and providing a desired        supply of fluid to the output nozzle.

Preferably, the tool is formed with a grooved portion which isconfigured so as to enable it to be readily grasped by a forceps tool.

According to a twenty-second aspect of the present invention there isprovided a multifunctional coil orienting and coating and pick and placetool comprising:

-   -   a base;    -   a body portion extending from the base; and    -   an arm extending outwardly from the body portion in a curved        manner and having a rounded tip.

Preferably, the multifunctional coil orienting and coating and pick andplace tool also comprises a spur element, disposed on a back surface ofthe arm. Preferably, the spur is configured to cooperate with a socketon a coil for assisting in the winding thereof. Also, preferably, thetool comprises a coil coating passage for supplying a liquid coatingmaterial to the coil as the coil passes therethrough.

According to a twenty-third aspect of the present invention there isprovided a coil bonding adhesive curing tool comprising:

-   -   a base, which is arranged to be coupled to a tool engagement        element of a hand;    -   an arm, extending outwardly from the base in a curved manner;        and    -   an ultraviolet light output device, mounted on an outward end of        the arm.

According to a twenty-fourth aspect of the present invention there isprovided a multifunctional disc replacement band orienting toolcomprising a base portion having integrally formed therewith a flexiblebatten having edge protrusions which correspond in cross-section tocross-sections of channels formed in facing end plates.

According to a twenty-fourth aspect of the present invention there isprovided a forceps tool comprising a base onto which are fixedly mountedfirst and second forceps fingers, the second forceps finger beingmounted for selectable positioning with respect to the first forcepsfinger, the tool being characterized in that respective mutually facingsurfaces of the first and second forceps fingers are formed with aprotrusion and a cooping and correspondingly positioned and configuredengagement surface.

According to a twenty-fifth aspect of the present invention there isprovided a disc replacement band engagement tool comprising

a base, and an arm extending outwardly from the base and terminating ina rounded tip, there being formed, along opposite side surfaces of thearm, pairs of protrusions which are adapted for operative engagementwith retaining sockets.

According to a twenty-sixth aspect of the present invention there isprovided a disc replacement band engagement tool comprising

a base, and a bent arm extending out from the base and terminating in acylindrical pin, the pin being adapted for engagement with at least oneaperture formed on the band.

According to a twenty-seventh aspect of the present invention there isprovided a tool operable for supplying a flowable polymer to a discreplacement band and comprising a base and at least first and secondnozzles, the first nozzle being coupled to a conduit which receives apressurized supply of flowable polymer, the first nozzle thus supplyingthe polymer via outlets to an interior of the band, and the secondnozzle being connected at another location at the interior of the bandand applying negative pressure thereto.

According to a twenty-eighth aspect of the present invention there isprovided a tool operable for inserting an inflatable implant retained ina folded orientation, the tool comprising a base portion including amounting aperture which is arranged to be engaged by the tool and havingintegrally formed therewith a generally cylindrical retaining portion.

According to a twenty-ninth aspect of the present invention there isprovided a flat disc replacement coil transporter and dispenserincluding a housing, comprising a plurality of mutually articulatedportions and enclosing at least one coil driving assembly including anelectric motor which drives a roller engaging a disc replacement coiland a coil feeder which feeds the coil into driving engagement with thecoil driving assembly.

In an embodiment, the housing includes first and second generallyelongate joined housing subassemblies.

In a further embodiment, the plurality of mutually articulated portionsare joined by flexible couplings.

In yet a further embodiment, each of the housing subassemblies includesthree housing sub-portions.

In yet a further embodiment, the plurality of mutually articulatedportions includes a forward facing housing portion which comprises aforward coil driving assembly including an electric motor operable todrive a roller, and wherein the roller forms part of a pinch rollerassembly.

In yet a further embodiment, the pinch roller assembly includes rollershaving cross-sections which correspond to the cross-sectionalconfigurations of both a lead portion and a main portion of a flat disccoil.

In yet a further embodiment, the forward facing housing portioncomprises a coil feeder operable to feed a flat coil into drivingengagement with the forward coil driving assembly.

In yet a further embodiment, the coil feeder has a general configurationof a funnel.

In yet a further embodiment there is also provided at least one quickconnection mounting assembly which is suitable for the mounting of ahand onto the housing.

In yet a further embodiment there is also provided a coil outletaperture located on a front face of the housing.

In yet a further embodiment, the coil outlet aperture is defined byrespective front faces of the first and second housing sub-portions.

In yet a further embodiment there is also provided at least one vehicledock for removable docking thereto of a surgical vehicle.

In yet a further embodiment there is also provided an intermediatehousing portion having an intermediate coil driving assembly.

In yet a further embodiment, the intermediate housing portion alsoincludes an intermediate coil feeder, operable to feed a coil intodriving engagement with the intermediate coil driving assembly.

In yet a further embodiment there is also provided a rearward housingportion, which includes a coil storage bay for storage of a coil in acoiled orientation therein.

In yet a further embodiment, the fiat disc replacement coil transporterand dispenser is configured so as not to fill all of the space in thethird cannula subassembly and not to engage all of the tracks, wherebysufficient room is left free inside the third cannula subassembly toenable operation of a surgical vehicle, supported on at least one trackthereof, alongside the fiat disc replacement coil transporter anddispenser.

In yet a further embodiment, the fat disc replacement coil transporterand dispenser is configured to define a plurality of longitudinalrecesses for mounting engagement with respective tracks of an outerportion of a third cannula subassembly. It preferably also comprises awinch.

In yet a further embodiment there is also provided a driving belt drivenby a sprocket drive assembly.

In yet a further embodiment, the sprocket drive assembly comprises amotor, and a sprocket driven by the motor, which is operative to drivethe driving belt, via a plurality of fairleads.

According to a thirtieth aspect of the present invention there isprovided a cannula system comprising:

-   -   at least one steerable cannula assembly; and    -   a controller operating the at least one steerable cannula        assembly.

Preferably the steerable cannula assembly also comprises at least onesteerable cannula; and cannula steering assembly removably associatedwith the at least one steerable cannula.

In an embodiment, the at least one steerable cannula comprises amulti-stage cannula assembly. Alternatively or additionally the at leastone steerable cannula comprises a multi-functional cannula assembly.

In an embodiment there is also provided a tracking system for tackingthe position of the at least one steerable cannula.

In yet a further embodiment there is also provided a cannula insertionassembly which is operative to insert at least one cannula into apatient at a desired location and a desired angle.

In yet a further embodiment, the cannula insertion assembly includes auniversal mounting assembly, at least two drive assemblies, which arereplaceably and modularly mountable onto the universal mountingassembly; and a multifunctional cannula assembly, operative inassociation with the universal mounting assembly and with the at leasttwo drive assemblies.

In yet a further embodiment, the multifunctional cannula assemblyincludes at least two different cannula subassemblies which are drivenby respective ones of the at least two drive assemblies.

In yet a further embodiment, the multifunctional surgical assemblyincludes a computerized operator interface.

In yet a further embodiment, the universal mounting assembly comprises acannula mounting assembly onto which are mounted the at least two driveassemblies.

In yet a further embodiment there is also provided a real-time imagingassembly.

In yet a further embodiment there is also provided an array of RFreceiving antennas which are used for sensing the precise orientationand position of elements of the multifunctional cannula subassembly.

In yet a further embodiment, the cannula mounting assembly comprises: aspherical bearing including a central aperture through which at leastone cannula subassembly, which forms part of the multifunctional cannulaassembly, may slidably extend; and a selectably orientatable socketmounted on the spherical bearing, for removably and replaceablyreceiving the at least two drive assemblies.

In yet a further embodiment, the selectably orientatable socket isselectably positionable in three dimensions by two or more pivotablymounted positioning pistons operated by a hydraulic driving controller.

In yet a further embodiment, the drive assemblies comprise a housingonto which is mounted firstly a linear driving motor controlled by alinear driving controller, and secondly a rotational driving motorcontrolled by a rotational driving controller.

In yet a further embodiment, the steerable cannula subassembly comprisesa central flexible core located within a flexible outer tube, the outertube containing therewithin curvature control tendons operable to betensioned or compressed to effect desired curvature of the at least onesteerable cannula subassembly.

In yet a further embodiment, the tendons are slidably disposed withinrespective elongate bores formed in the core and are removably couplableto a drive assembly for linear driving of the tendons in a push-pullmanner for applying tension or compression to the tendon fixed thereto.

In yet a further embodiment, the steerable cannula assembly alsocomprises at least one electrical conductor for supplying electricalpower to at least one electrical signal beacon transducers which aresensible by at least one of the elements of a real time imagingassembly, thereby to enable the precise location and orientation of theat least one steerable cannula subassembly to be ascertained andmonitored.

In yet a further embodiment, the at least one steerable cannula assemblyalso comprises an elongate recess formed along a majority of the lengthof a cannula, the recess being engageable by a suitable protrusionconnected to gearing for rotational driving of the cannula.

According to a thirty-first aspect of the present invention there isprovided a self-propelled surgical vehicle comprising:

-   -   a body of generally uniform cross-section and defining forward        and rearward faces;    -   at least one freely rolling roller mounted on the body; and    -   a driving roller, powerable by an electric motor, disposed        within the body.

Preferably, the self-propelled surgical vehicle also comprises a quickconnection mounting assembly located at one of the forward and rearwardfaces of the body.

In an embodiment, the forward face of the body is formed with aplurality of recesses which are employable for assisting in the mountingof auxiliary elements onto the vehicle.

In a further embodiment, the body is formed with at least onelongitudinal recess which extends along edges of the body and in whichis disposed the at least one freely rolling rollers.

In yet a further embodiment, the driving roller is disposed in the atleast one longitudinal recess.

In yet a further embodiment, the at least one freely rotating roller isoperable to roll along at least one track formed in a cannula and thedriving roller is operable to drivingly engage cogs formed along atleast another tram formed in the cannula or precision longitudinalpositioning of the vehicle along the tracks.

In yet a further embodiment, the electric motor is controlled by amultifunctional controller via a control cable which extends through thecannula.

In yet a ether embodiment, auxiliary electrical power is providable forauxiliary elements attached to the forward face by means of an auxiliarypower cable which is removably couplable to a socket formed on therearward face.

In yet a further embodiment, auxiliary electrical control is providedfor the auxiliary elements attachable to the forward face by means of anauxiliary control cable which is removably couplable to the rearwardface and extendable through the cannula.

In yet a filer embodiment, the body is formed with a throughgoing bore.

In yet a further embodiment, the body is formed with a pair oflongitudinal recesses which extend along edges of the body and in whichare disposed the at least two freely rolling rollers and a thirdlongitudinal recess along which are disposed at least one freely rollingroller and a driving roller, the driving roller being powerable by anelectric motor disposed within the body.

In yet a further embodiment, the third longitudinal recess is formed atits ends with a cross-sectional configuration defining an undercut whichmaintains operative engagement between the at least one freely rollingroller and the driving roller and the track and thus enables the vehicleto ride on the single track.

According to a thirty-second aspect of the present invention there isprovided a non-self-propelled surgical vehicle comprising at least oneelement having a generally uniform cross-sectional configuration,including an undercut, and which is operable to maintain operativeengagement between the vehicle and a track on a cannula. Preferably, theelement is adapted to be translated along the track by an externalelectric motor. Again, preferably the vehicle comprises a quickconnector located on a surface of the element for connection thereto ofone or more auxiliary elements.

The vehicle may also comprise a universal hand which is employable inassociation with the surgical vehicle, the universal hand including abase, which, is removably coupled to the surgical vehicle; and at leastfirst and second intermediate elements rotatable relative to the baseabout a longitudinal axis in the base by an electric motor and includinga tool engagement element. There may be more than one such vehicle.

The vehicle may comprise at least one tool mounted on the toolengagement element.

In an embodiment, the at least one tool is selected from the followingtools: a milling head, a forceps tool, a forceps finger, an fluiddispenser tool, a pick and place tool, an articulated element, aninflation tool a gauging tool and a cutting tool.

According to a thirty-fourth aspect of the present invention there isprovided a method of treating scoliosis comprising the steps ofinserting a disc replacement coil intermediate adjacent vertebra.Preferably, the disc replacement coil is in the form of a wedge which isattached at a seat and secured to at least one vertebra end plate.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood and appreciated more fully fromthe following detailed description, taken in conjunction with thedrawings in which:

FIG. 1 is a simplified illustration of a patient supported by and fixedto a support table, preferably used both for imaging and for operating;

FIG. 2 is a simplified illustration of imaging of a patient fixed to asupport table of the type illustrated in FIG. 1;

FIG. 3 is a simplified illustration of an image of a patient showing aportion of the spinal region imaged by the technique illustrated in FIG.2;

FIGS. 4A, 4B and 4C are respective illustrations of a healthy spinaldisc, a diseased spinal disc and a spinal disc reconstructed inaccordance with a preferred embodiment of the present invention, alllocated at the portion of the spinal region shown in FIG. 3;

FIG. 5 is a simplified partially-block diagram illustration of amulti-functional surgical assembly constructed and operative inaccordance with a preferred embodiment of the present invention which isuseful in carrying out treatment of spinal disorders in accordance witha preferred embodiment of the present invention;

FIGS. 6A and 6B are simplified pictorial illustrations of a universalmounting assembly constructed and operative in accordance with apreferred embodiment of the present invention;

FIG. 7 is a simplified pictorial illustration of a cannula mountingassembly constructed and operative in accordance with a preferredembodiment of the present invention;

FIGS. 8A, 8B and 8C are illustrations of respective first second andthird drive assemblies which cooperate with the cannula mountingassembly of FIG. 7;

FIG. 9 is a simplified illustration of a multi-functional cannulaassembly constructed and operative in accordance with a preferredembodiment of the present invention;

FIGS. 10A and 10B are simplified respective sectional and pictorialillustrations of a first cannula subassembly forming part of themulti-functional cannula assembly of FIG. 9;

FIGS. 11A, 11B, 11C and 11D are sectional illustrations taken alongrespective lines XIA-XIA, XIB-XIB, XIC-XIC and XID-XID in FIGS. 10A and10B;

FIGS. 12A, 12B and 12C are illustrations of a cannula steeringsubassembly constructed and operative in accordance with a preferredembodiment of the present invention in three different operativeorientations;

FIG. 13 is a simplified sectional illustration of a second cannulasubassembly forming part of the multi-functional cannula assembly ofFIG. 9;

FIG. 14 is a sectional illustration taken along lines XIV-XIV in FIG.13;

FIGS. 15A and 15B are simplified illustrations showing engagementbetween the first and second cannula subassemblies in accordance with apreferred embodiment of the present invention in first and secondoperative orientations respectively;

FIG. 16 is a simplified illustration of a third cannula subassemblyforming part of the multi-functional cannula assembly of FIG. 9 as wellas a tool staging assembly operative in cooperation therewith;

FIG. 17 is a simplified sectional illustration taken along linesXVII-XVII of FIG. 16 illustrating mutually slidable inner and outerportions of the third cannula subassembly;

FIGS. 18A and 18B are simplified illustrations showing engagementbetween the second and third cannula subassemblies in accordance with apreferred embodiment of the present invention;

FIG. 19 is a simplified enlarged illustration of part of the cannulasubassembly of FIG. 16;

FIG. 20 is a simplified pictorial illustration of the operation of aportion of the cannula subassembly of FIGS. 16-19 in an operatingenvironment;

FIG. 21 is a simplified illustration showing a view of the operatingenvironment provided to an operator by the portion of the cannulasubassembly shown in FIG. 20.

FIG. 22 is a simplified pictorial illustration of a portion of the thirdcannula subassembly of FIGS. 16 and 17 containing three self-propelledsurgical vehicles constructed and operative in accordance with apreferred embodiment of the present invention;

FIGS. 23A and 23B are two pictorial illustrations of a firstself-propelled surgical vehicle operative in cooperation with the thirdcannula subassembly in accordance with a preferred embodiment of thepresent invention;

FIGS. 24A and 24B are two pictorial illustrations of a secondself-propelled surgical vehicle operative in cooperation with the thirdcannula subassembly in accordance with a preferred embodiment of thepresent invention;

FIGS. 25A and 25B are two pictorial illustrations of a thirdself-propelled surgical vehicle operative in cooperation with the thirdcannula subassembly in accordance with a preferred embodiment of thepresent invention;

FIG. 26 is a simplified pictorial illustration of a portion of the thirdcannula subassembly of FIGS. 16 and 17 containing four nonself-propelled surgical vehicles constructed and operative in accordancewith a preferred embodiment of the present invention;

FIG. 27 is a pictorial illustration of a hand which is employed inassociation with the surgical vehicles shown in FIGS. 23A-26;

FIGS. 28A, 28B, 28C, 28D & 28E are pictorial illustrations of millingheads useful in the present invention;

FIGS. 29A, 29B, 29C, 29D, 29E, 29F, 29G and 29H are pictorialillustrations of tools which are employed in association with the handof FIG. 27;

FIG. 30A is an exploded view illustration of a staging assembly employedin the staging complex shown in FIG. 32C;

FIG. 30B is an exploded view illustration of the staging assembly ofFIG. 30A having a pair of tools mounted on a pair of tracks thereof;

FIG. 30C is a partially cut-away illustration of the staging assembly ofFIG. 30B having a pair of tools mounted on a pair of tracks hereof in anat least partially assembled state as well as additional tracks;

FIG. 31A and FIG. 31B are respective sectional and pictorialillustrations of the assembled staging assembly of FIG. 30C, thesectional illustration being taken along lines XXXI-XXXI of FIG. 30C andthe pictorial illustration showing the staging assembly mounted onto thethird cannula subassembly;

FIG. 32A is a general pictorial illustration of an operating environmentemploying a preferred embodiment of the present invention;

FIG. 32B is a general pictorial illustration of an operator interfaceforming part of the operating environment of FIG. 32A;

FIG. 32C is a general pictorial illustration of an staging complexforming part of the operating environment of FIG. 32A;

FIG. 32D is a composite virtual image of the possible relativepositioning of the operator vis-a-vis a portion of the spine of apatient;

FIGS. 33A, 33B and 33C illustrate the spinal region of a patient asvirtually viewed by the operator in three different relative operatingpositions among the positions shown in FIG. 32D;

FIG. 34 is a general block diagram of the operator interface which formspart of the operating environment of FIGS. 30-33C;

FIG. 35 is a generalized flowchart illustrating the general operation ofan operator visualization subsystem shown in FIG. 34;

FIGS. 36A and 36B are together a flowchart illustrating step A shown inthe flowchart of FIG. 35;

FIG. 37 is a flowchart illustrating step B shown in the flowchart ofFIG. 35;

FIG. 38 is a flowchart illustrating step C shown in the flowchart ofFIG. 35;

FIGS. 39A, 39B, 39C and 39D are together a flowchart illustrating step Dshown in the flowchart of FIG. 35;

FIG. 40 is a flowchart illustrating step E shown in the flowchart ofFIG. 35;

FIG. 41 is a flowchart illustrating step F shown in the flowchart ofFIG. 35;

FIG. 42 is a generalized flowchart illustrating the general operation ofthe operator-controlled driving subsystem shown in FIG. 34;

FIG. 43 is a flowchart illustrating step A shown in the flowchart ofFIG. 42;

FIGS. 44A and 44B are together a flowchart illustrating steps B and Cshown in the flowchart of FIG. 42;

FIG. 45 is a flowchart illustrating step D shown in the flowchart ofFIG. 42;

FIGS. 46A, 46B and 46C are together a flowchart illustrating steps E andF shown in the flowchart of FIG. 42;

FIG. 47 is a flowchart illustrating step G shown in the flowchart ofFIG. 42;

FIG. 48 is a simplified illustration of a portion of the intendednavigation path of the first cannula subassembly in the environment of adysfunctional spinal disc and adjacent respective upper and lowervertebrae;

FIGS. 49A, 49B, 49C, 49D and 49E are simplified illustrations of variousstages in reconstruction of a vertebra end plate in accordance with apreferred embodiment of the present invention;

FIGS. 50A, 50B and 50C are simplified illustrations of various stages inreconstructing a vertebra end plate in accordance with another preferredembodiment of the present invention;

FIGS. 51A, 51B and 51C are simplified illustrations of various stages inreconstructing a vertebra end plate in accordance with yet anotherpreferred embodiment of the present invention;

FIGS. 52A, 52B and 52C are simplified illustrations of various stages inplanning milling of a vertebra end plate in accordance with a preferredembodiment of the present invention;

FIGS. 53A, 53B and 53C are simplified illustrations of various stages inplanning insertion of the implant between adjacent facing vertebra endplates;

FIGS. 54A and 54B are respective two-dimensional diagrammatic andthree-dimensional pictorial illustrations of insertion of the firstcannula subassembly;

FIG. 55 is a two-dimensional diagrammatic illustration of anchoring ofthe first cannula subassembly;

FIGS. 56A and 56B are respective two-dimensional diagrammatic andthree-dimensional pictorial illustrations of insertion of the secondcannula subassembly;

FIGS. 57A and 57B are respective two dimensional diagrammatic andthree-dimensional pictorial illustrations of insertion of the thirdcannula subassembly;

FIGS. 58A and 58B are simplified respective composite sectional, takenalong section lines LXIV1-LXIV1 and LXIV2-LXIV2 in FIG. 57B, andthree-dimensional pictorial illustrations showing insertion of the thirdcannula subassembly;

FIGS. 59A and 59B are simplified respective composite sectional andthree-dimensional pictorial illustrations showing engagement of theforward edge of the inner portion of the third cannula subassembly witha vertebra;

FIGS. 60A and 60B are simplified respective composite sectional andthree-dimensional pictorial illustrations showing engagement of theforward edge of the outer portion of the third cannula subassembly withthe vertebra;

FIGS. 61A and 61B are simplified respective composite sectional andthree-dimensional pictorial illustrations showing anchoring the thirdcannula subassembly on a vertebra;

FIGS. 62A and 62B are simplified respective composite sectional andthree-dimensional pictorial illustrations showing removal of the firstand second cannula subassemblies and the inner portion of the thirdcannula subassembly;

FIGS. 63 and 64 are simplified pictorial illustrations illustrating discsuctioning;

FIGS. 65A, 65B, 65C, 65D, 65E and 65F are simplified illustrations ofvarious stages in reconstructing a vertebra end plate in accordance withone preferred embodiment of the present invention;

FIGS. 66A, 66B and 66C are simplified illustrations of various stages inreconstructing a vertebra end plate in accordance with another preferredembodiment of the present invention;

FIGS. 67A, 67B, 67C and 67D are simplified illustrations of variousstages in reconstructing a vertebra end plate in accordance with yetanother preferred embodiment of the present invention;

FIG. 68 is a simplified pictorial illustration of one phase of end platemachining;

FIGS. 69A, 69B and 69C are simplified pictorial illusions of a furtherphase of end plate machining in accordance with three alternativeembodiments of the present invention;

FIGS. 70A, 70B, 70C, 70D, 70E & 70F are simplified pictorialillustrations of yet another phase of end plate machining in accordancewith six alternative embodiments of the present invention;

FIGS. 71A and 71B are illustrations of two alternative cross-sectionalconfigurations for a peripheral channel in the embodiments of FIGS. 70Aand 70B;

FIGS. 72A and 72B are illustrations of two alternative cross-sectionalconfigurations for a peripheral channel in the embodiments of FIGS. 70Cand 70D;

FIGS. 73A, 73B, 73C, 73D, 73E, 73F, 73G & 73H are simplified pictorialillustrations of eight variations of an inflatable implant constructedand operative in accordance with a preferred embodiment of the presentinvention;

FIGS. 74A, 74B, 74C, 74D, 74E, 74F, 74G & 74H are simplified sectionalillustrations corresponding to FIGS. 73A, 73B, 73C, 73D, 73E, 73F, 73G &73H;

FIGS. 75A and 75B are simplified pictorial illustrations of twoalternative structures of an inflatable implant constructed andoperative in accordance with another preferred embodiment of the presentinvention;

FIGS. 76A, 76B, 76C, 76D, 76E, 76F, 76G, 76H, 76I, 76J & 76K aresimplified pictorial illustrations of eleven variations of a flat discreplacement coil constructed and operative in accordance with a firstpreferred embodiment of the present invention;

FIGS. 77A, 77B, 77C, 77D, 77F, 77F, 77G, 77H, 77I, 77J & 77K aresimplified sectional illustrations corresponding to FIGS. 76A, 76B, 76C,76D, 76E, 76F, 76G, 76H, 76I 76J & 76K taken along respective finesLXXVIIA-LXXVIIA, LXXVIIB-LXXVIIB, LXXVIIC-LXXVIIC, LXXVIID-LXXVIID,LXXVIIE-LXXVIIE, LXXVIIF-LXXVIIF, LXXVIIG-LXXVIIG, LXXVIIH-LXXVIIH,LXXVIII-LXXVIII, LXXVIIJ-LXXVIIJ & LXXVIIK-LXXVIIK;

FIGS. 78A, 78B, 78C, 78D, 78E, 78F, 78G, 78H, 78I, 78J & 78K aresimplified sectional illustrations corresponding to FIGS. 76A, 76B, 76C,76D, 76E, 76F, 76G, 76H, 76I, 76J & 76K taken along respective linesLXXVIIIA-LXXVIIIA, LXXVIIIB-LXXVIIIB, LXXVIIIC-LXXVIIIC,LXXVIIID-LXXVIIID, LXXVIIIE-LXXVIIIE, LXXVIIIF-LXXVIIIF,LXXVIIIG-LXXVIIIG, LXXVIIIH-LXXVIIIH, LXXVIII-LXXVIII, LXXVIIIJ-LXXVIIIJ& LXXVIIIK-LXXVIIIK;

FIG. 79 is a pictorial illustration in exploded view format of a flatdisc replacement coil transporter and dispenser constructed andoperative in accordance with a preferred embodiment of the presentinvention;

FIGS. 80A & 80B are sectional illustrations taken along respective finesLXXXA-LXXXA & LXXXB-LXXXB in FIG. 79;

FIGS. 81A, 81B, 81C & 81D are pictorial illustrations of four differenttools useful in association with the flat disc replacement coiltransporter and dispenser of FIG. 79;

FIGS. 82A and 82B are simplified pictorial illustrations of inaction andinflation of the embodiment of inflatable implant of FIG. 75A betweenfacing end plates of adjacent vertebrae;

FIGS. 83A and 83B are sectional illustrations taken along respectivelines LXXXIIIA-LXXXIIIA and LXXXIIIB-LXXXIIIB in FIGS. 82A and 92B;

FIGS. 84A and 84B are simplified pictorial illustrations of insertionand inflation of another embodiment of inflatable implant between facingend plates of adjacent vertebrae;

FIGS. 85A and 85B are sectional illustrations taken along linesLXXXV-LXXXV in FIGS. 84A and 84B;

FIGS. 86A and 86B are respective pictorial and partially cut-awaypictorial views illustrating a first stage in the insertion of a flatdisc replacement coil in accordance with a first embodiment of thepresent invention;

FIGS. 87A and 87B are respective pictorial and partially cut-awaypictorial views illustrating a second stage in the insertion of a flatdisc replacement coil in accordance with a first embodiment of thepresent invention;

FIGS. 88A and 88B are respective pictorial and partially cut-awaypictorial views illustrating a third stage in the insertion of a flatdisc replacement coil in accordance with a first embodiment of thepresent invention;

FIGS. 89A and 89B are respective pictorial and partially cut-awaypictorial views illustrating a fourth stage in the insertion of a flatdisc replacement coil in accordance with a first embodiment of thepresent invention;

FIGS. 90A and 90B are simplified sectional illustrations illustratingdeflation of an inflatable implant following insertion of a flat discreplacement coil in accordance with a first embodiment of the presentinvention;

FIG. 91 is a pictorial illustration in exploded view format of a flatdisc replacement coil transporter and dispenser constructed andoperative in accordance with a preferred embodiment of the presentinvention;

FIGS. 92A and 92B are pictorial illustrations of two different toolsuseful in association with the flat disc replacement coil transporterand dispenser of FIG. 91;

FIGS. 93A and 93B are simplified pictorial illustrations of insertionand inflation of an embodiment of inflatable implant between facing endplates of adjacent vertebrae;

FIGS. 94A and 94B are sectional illustrations taken along respectivelines LXXXXIVA-LXXXXIVA LXXXXIVB-LXXXXIVB in FIGS. 93A and 93B;

FIGS. 95A and 95B are respective pictorial and partially cut-awaypictorial views illustrating a first stage in the insertion of a flatdisc replacement coil in accordance with a second embodiment of thepresent invention;

FIGS. 96A and 96B are respective pictorial and partially cut-awaypictorial views illustrating a second stage in the insertion of a flatdisc replacement coil in accordance with a second embodiment of thepresent invention;

FIGS. 97A and 97B are respective pictorial and partially cut-awaypictorial views illustrating a third stage in the insertion of a flatdisc replacement coil in accordance with a second embodiment of thepresent invention;

FIGS. 98A, 98B, 98C, 98D, 98E, 99F, 98G, 98H, 98I, 98J & 98K aresectional illustrations of the plurality of alternative flat discreplacement coil configurations of FIGS. 76A-76K, 77A-77K and 78A-78Kinstalled in situ between facing vertebrae 2004 and 2005 in accordancewith a preferred embodiment of the present invention;

FIG. 99 is a partially sectional partially pictorial illustration of adouble coil arrangement installed in situ between facing vertebrae 2004and 2005 in accordance with another preferred embodiment of the presentinvention;

FIGS. 100A, 100B, 100C, 100D & 100E are simplified exploded viewpictorial illustrations of five variations of an inflatable implantassembly constructed and operative in accordance with another preferredembodiment of the present invention;

FIGS. 101A, 101B, 101C, 101D & 101E are simplified sectionalillustrations corresponding to FIGS. 100A, 100B, 100C, 100D & 100E;

FIGS. 102A, 102B, 102C, 102D, 102E, 102F & 102G are simplified pictorialillustrations of eleven variations of an upstanding disc replacementcoil constructed and operative in accordance with a first preferredembodiment of the present invention;

FIGS. 103A, 103B, 103C, 103D, 103E, 103F & 103G are simplified sectionalillustrations corresponding to FIGS. 102A, 102B, 102C, 102D, 102E, 102F& 102G, taken along respective lines CIIIA-CIIIA, CIIIB-CIIIB,CIIIC-CIIIC, CIIID-CIIID, CIIIE-CIIIE, CIIIF-CIIIF & CIIIG-CIIIG;

FIGS. 104A, 104B, 104C, 104D, 104E, 104F & 104G are simplified sectionalillustrations corresponding to FIGS. 102A, 102B, 102C, 102D, 102E, 102F& 102G, taken along respective lines CIVA-CIVA, CIVB-CIVB, CIVC-CIVC,CIVD-CIVD, CIVE-CIVE, CIVF-CIVF & CIVG-CIVG;

FIG. 105 is a pictorial illustration in exploded view format of anupstanding disc replacement coil transporter and dispenser constructedand operative in accordance with a preferred embodiment of the presentinvention;

FIGS. 106A, 106B, 106C & 106D are pictorial illustrations of fourdifferent tools useful in association with the upstanding discreplacement coil transporter and dispenser of FIG. 105;

FIGS. 107A and 107B are simplified pictorial illustrations of insertionand inflation of an inflatable implant assembly between facing endplates of adjacent vertebrae;

FIGS. 108A and 108B are sectional illustrations taken along respectivelines CVIIIA-CVIIIA and CVIIIB-CVIIIB in FIGS. 107A and 107B;

FIG. 109 is a pictorial view illustrating a first stage in the insertionof an upstanding disc replacement coil in accordance with a firstembodiment of the present invention;

FIG. 110 is a pictorial view illustrating a second stage in theinsertion of an upstanding disc replacement coil in accordance with afirst embodiment of the present invention;

FIG. 111 is a pictorial view illustrating a third stage in the insertionof an upstanding disc replacement coil in accordance with a firstembodiment of the present invention;

FIG. 112 is a pictorial view illustrating a fourth stage in theinsertion of an upstanding disc replacement coil in accordance with afirst embodiment of the present invention;

FIG. 113 is a simplified sectional illustration illustrating deflationof an inflatable implant following insertion of an upstanding discreplacement coil in accordance with a first embodiment of the presentinvention;

FIGS. 114A and 114B are simplified pictorial illustrations of twovariations of an inflatable implant constructed and operative inaccordance with yet another preferred embodiment of the presentinvention;

FIGS. 115A and 115B are simplified sectional illustrations correspondingto FIGS. 114A and 114B;

FIGS. 116A and 116B are simplified pictorial illustrations of twovariations of an upstanding disc replacement coil constructed andoperative in accordance with another preferred embodiment of the presentinvention;

FIGS. 117A and 117B are simplified sectional illustrations correspondingto FIGS. 116A and 116B taken along respective lines CXVIIA-CXVIIA andCXVIIB-CXVIIB;

FIGS. 118A and 118B are simplified sectional illustrations correspondingto FIGS. 116A and 116B taken along respective lines CXVIIIA-CXVIIIA andCXVIIIB-CXVIIIB;

FIG. 119 is a pictorial illustration in exploded view format of anupstanding disc replacement coil transporter and dispenser constructedand operative in accordance with a preferred embodiment of the presentinvention;

FIGS. 120A & 120B are pictorial illustrations of two different toolsuseful in association with the upstanding disc replacement coiltransporter and dispenser FIG. 119;

FIGS. 121A and 121B are simplified pictorial illustrations of insertionand inflation of the inflatable implant of FIG. 114A between facing endplates of adjacent vertebras;

FIGS. 122A, 122B & 122C are sectional illustrations, FIG. 122Acorresponding to FIG. 121A and being taken along lines CXXIIA-CXXIIAthereof and FIGS. 122B and 122C corresponding to FIG. 121B at two levelsof inflation of the inflatable implant and being taken along linesCXXIIBC-CXXIIBC thereof;

FIG. 123 is a pictorial view illustrating a first stage in the insertionof an upstanding disc replacement coil in accordance with a secondembodiment of the present invention;

FIG. 124 is a pictorial view illustrating a second stage in theinsertion of an upstanding disc replacement coil in accordance with asecond embodiment of the present invention;

FIG. 125 is a pictorial view illustrating a third stage in the insertionof an upstanding disc replacement coil in accordance with a secondembodiment of the present invention;

FIG. 126 is a pictorial view illustrating a fourth stage in theinsertion of an upstanding disc replacement coil in accordance with asecond embodiment of the present invention;

FIG. 127 is a pictorial view illustrating a fifth stage in the insertionof an upstanding disc replacement coil in accordance with a secondembodiment of the present invention;

FIG. 128 is a pictorial view illustrating a sixth stage in the insertionof an upstanding disc replacement coil in accordance with a secondembodiment of the present invention;

FIG. 129 is a pictorial view illustrating a seventh stage in theinsertion of an upstanding disc replacement coil in accordance with asecond embodiment of the present invention;

FIGS. 130A, 130B, 130C, 130D, 130E, 130F and 130G are sectionalillustrations of the plurality of alternative upstanding discreplacement coil configurations of FIGS. 102A-102G, 116A & 116B;103A-103G, 117A & 117B; and 104A-104G, 118A & 118B installed in situbetween facing vertebrae 2004 and 2005 in accordance with a preferredembodiment of the present invention;

FIGS. 131A, 131B, 131C & 131D are simplified pictorial illustrations offour variations of a filament wound disc replacement coil constructedand operative in accordance with another preferred embodiment of thepresent invention;

FIGS. 132A, 132B, 132C & 132D are simplified sectional illustrationscorresponding to FIGS. 131A, 131B, 131C & 131D, taken along respectivelines CXXXIIA-CXXXIIA, CXXXIIB-CXXXIIB, CXXXIIC-CXXXIIC &CXXXIID-CXXXIID;

FIGS. 133A, 133B, 133C & 133D are simplified sectional illustrationscorresponding to FIGS. 131A, 131B, 131C & 131D, taken along respectivelines CXXXIIIA-CXXXIIIA, CXXXIIIB-CXXXIIIB, CXXXIIIC-CXXXIIIC &CXXXIIID-CXXXIIID;

FIG. 134 is a pictorial illustration in exploded view format of anupstanding disc replacement coil transporter and dispenser constructedand operative in accordance with a preferred embodiment of the presentinvention;

FIGS. 135A and 135B are pictorial illustrations of two different toolsuseful in association with the upstanding disc replacement coiltransporter and dispenser of FIG. 134;

FIGS. 136A and 136B are simplified pictorial illustrations of insertionand inflation of an inflatable implant assembly between facing endplates of adjacent vertebrae in accordance with another embodiment ofthe present invention;

FIG. 137 is a pictorial view illustrating a first stage in the insertionof a wound filament disc replacement in accordance with anotherembodiment of the present invention;

FIG. 138 is a pictorial view illustrating a second stage in theinsertion of the wound filament disc replacement;

FIG. 139 is a pictorial view illustrating a third stage in the insertionof the wound filament disc replacement;

FIG. 140 is a pictorial view illustrating a fourth stage in theinsertion of the wound filament disc replacement;

FIG. 141 is a pictorial view illustrating a fifth stage in the insertionof the wound filament disc replacement;

FIG. 142 is a pictorial view illustrating a sixth stage in the insertionof the wound filament disc replacement;

FIG. 143 is a pictorial view illustrating a seventh stage in theinsertion of the wound filament disc replacement;

FIG. 144 is a simplified sectional illustration illustrating deflationof an inflatable implant following insertion of a wound filament discreplacement in accordance with another embodiment of the presentinvention;

FIG. 145 is a sectional illustration of a wound disc replacement coilinstalled in situ between facing vertebrae 2004 and 2005 in accordancewith a preferred embodiment of the present invention;

FIGS. 146A, 146B, 146C, 146D, 146E & 146F are simplified pictorialillustrations of five variations of an inflatable implant constructedand operative in accordance with another preferred embodiment of thepresent invention;

FIGS. 147A, 147B, 147C, 147D, 147E & 147F are simplified sectionalillustrations corresponding to FIGS. 146A, 146B, 146C, 146D, 146E &146F;

FIG. 148 is a pictorial illustration of a generic disc replacement bandconstructed and operative in accordance with an embodiment of theinvention and useful with the inflatable implants of FIGS. 146A-147E;

FIGS. 149A, 149B, 149C, 149D & 149E are simplified sectionalillustrations of variations of the band of FIG. 148;

FIG. 150 is a pictorial illustration of disc replacement bandconstructed and operative in accordance with another embodiment of theinvention and useful with the inflatable implant of FIGS. 146D & 147D;

FIG. 151 is a simplified sectional illustration of the band of FIG. 150;

FIG. 152 is a pictorial illustration of a generic disc replacement bandconstructed and operative in accordance with yet another embodiment ofthe invention and useful with the inflatable implant of FIGS. 146C &147C;

FIGS. 153A & 153B are simplified sectional illustrations of variationsof the band of FIG. 152;

FIGS. 154A, 154B, 154C, 154D, 154E & 154F are pictorial illustrations oftools which are employed in association with the hand of FIG. 27 for usewith the inflatable implants and disc replacement bands of FIGS.146A-153B;

FIGS. 155A, 155B and 155C are simplified pictorial illustrations ofinsertion, inflation and removal of the inflatable implants of any ofFIGS. 146A-147E at facing end plates of adjacent vertebrae;

FIGS. 156A, 156B, 156C & 156D are sectional illustrations, FIG. 156Acorresponding to FIG. 155A and being taken along lines CLVA-CLVA thereofFIGS. 156B and 156C corresponding to FIG. 155B at two levels ofinflation of the inflatable implant and being taken along linesCLVBC-CLVBC thereof and FIG. 156D corresponding to FIG. 155C;

FIGS. 157, 158, 159 & 160 are simplified pictorial illustrations of fourstages in the insertion of the disc replacement bands of FIGS. 148A-153Bbetween facing end plates of adjacent vertebrae;

FIGS. 161A & 161B are simplified pictorial illustrations of two stagesin the insertion of any of the inflatable implants illustrated in FIGS.146A-146C and FIGS. 147A-147C between facing end plates of adjacentvertebrae following the steps illustrated in FIGS. 157-159;

FIGS. 162A & 162B are simplified pictorial illustrations of two stagesin the insertion of the inflatable implant of FIGS. 146D & 147D togetherwith a disc replacement band subassembly including and either of thebands shown in FIGS. 149A & 149E between facing end plates of adjacentvertebrae;

FIGS. 163A, 163B, 163C, 163D, 163E, 163F & 163G are partially sectionalpartially pictorial illustrations of the plurality of alternative discreplacement implant assemblies of FIGS. 146A-162 installed in situbetween facing vertebrae in accordance with a preferred embodiment ofthe present invention;

FIGS. 164A and 164B are simplified sectional illustrations of adjacentvertebra having therebetween a replacement disc provided in accordancewith one embodiment of the present invention in respective straight andflexed operative orientations, corresponding to a section taken alonglines A-A in FIG. 4C;

FIGS. 165A and 165B are simplified sectional illustrations of adjacentvertebra having therebetween a replacement disc provided in accordancewith another embodiment of the present invention in respective straightand flexed operative orientations, corresponding to a section takenalong lines A-A in FIG. 4C;

FIGS. 166A and 166B are simplified sectional illustrations of adjacentvertebra having therebetween a replacement disc provided in accordancewith still another embodiment of the present invention in respectivestraight and flexed operative orientations, corresponding to a sectiontaken along lines A-A in FIG. 4C;

FIGS. 167A and 167B are simplified sectional illustrations of adjacentvertebra having therebetween a replacement disc provided in accordancewith yet another embodiment of the present invention in respectivestraight and flexed operative orientations, corresponding to a sectiontaken along lines A-A in FIG. 4C;

FIGS. 168 and 169 are simplified pictorial illustrations of two phasesof end plate machining carried out as part of a technique for spinalfusion in accordance with a preferred embodiment of the presentinvention;

FIGS. 170A, 170B, 170C and 170D are simplified pictorial illustrationsof four stages in the insertion of bone grafts carried out as part of atechnique for spinal fusion in accordance with a preferred embodiment ofthe present invention;

FIG. 171 is a simplified pictorial illustration of a bone graft segmentenclosed within a fiber sleeve in accordance with an embodiment of thepresent invention;

FIG. 172 is a simplified pictorial illustration of a bone graft assemblycomprising a plurality of segments, each enclosed within a fiber sleeve,which are together enclosed within a fiber assembly enclosure inaccordance with an embodiment of the present invention;

FIG. 173 is a simplified pictorial illustration, corresponding to thatof FIG. 170D and employing the bone graft assembly of FIG. 171; and

FIGS. 174A and 174B are simplified sectional illustrations of adjacentvertebra having therebetween bone graft assemblies respectively of thetypes shown in FIGS. 170D and 173 provided in accordance with yetanother embodiment of the present invention.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The description which follows describes surgical apparatus andtechniques in the context of spinal surgery. It is to be appreciatedthat the apparatus and techniques described hereinbelow may haveapplicability to various fields of surgery beyond those dealing with thespine. Therefore, the description which follows is intended to be takenas an example of a preferred embodiment of the invention and not aslimiting the invention to the field of spinal surgery.

Reference is now made to FIG. 1, which illustrates a patient supportedby and fixed to a support table 100, constructed and operative inaccordance with a preferred embodiment of the present invention andpreferably used both for imaging and for operating.

Support table 100 preferably includes a chest support portion 102including a padded headrest 104, and which is associated with a pair ofside armrests 106 and 108. A plurality of intermediate support elements110, typically three in number, is selectably positionable with respectto a longitudinal axis 112 of chest support portion 102, as by one ormore electric motors 113, to accommodate any existing or desiredorientation of the patient, such as that resulting from curvature of thespine of the patient or that desired to enhance ease of access to oneside of the spine. The motors 113 are preferably controlled by arotational driving controller 114.

The legs and pelvis of the patient are preferably supported by a lowerbody support portion 115, having a longitudinal axis 116, which isangled in the plane of support table 100 with respect to axis 112 by asuitable angle, selected to accommodate any existing or desiredorientation of the patient, such as that resulting from curvature of thespine of the patient or that desired to enhance ease of access to oneside of the spine. Lower body support portion 115 is preferably formedwith a padded leg rest 117.

In accordance with a preferred embodiment of the present invention thelower body support portion 115, having be selectably positionablerelative to chest support portion 102 and intermediate support elements110, as by means of an electric motor 118 which typically produceslinear movement of the lower body support portion 115 in response tocontrol inputs from a linear driving controller 119.

The patient is securely braced onto chest support portion 102 by meansof a back brace assembly 120. Bolts 122 or other removable fasteners areemployed for securing the back brace assembly 120 onto chest supportportion 102. Similarly, the pelvis of the patient is securely bracedonto the lower body support portion 115 by means of a pelvic braceassembly 124, typically employing bolts 125, and the thighs of thepatient are braced onto lower body support portion 115 by thigh braceassemblies 126, typically employing bolts 127. The various braceassemblies are preferably formed of rigid plastic onto which are mountedinflatable portions for providing a tight fit to each individual bodycontour.

An equipment support base 130 may be mounted over the back of thepatient and may be supported onto back brace assembly 120. Alternativelyit may be independently rigidly mounted onto the chest support portion102 or to another location on support table 100.

Once the patient has been securely strapped to support table 100, thespinal region of the patient may be imaged by any suitable imagingapparatus and technology, as indicated, for example in FIG. 2. Suitableapparatus and technologies may be magnetic resonance imaging (MRI), andcomputerized tomography (CT).

The position of the patient may be varied from image to image or evenduring imaging, as by moving the various portions of the table 100relative to each other. For each suitable orientation of the patient,the patient may be imaged in a plurality of sections, such as sectionsindicated by reference numbers 136, 138, 140 and 142, in FIG. 2.

Images of sections of the patients body may be displayed on a display146 which is driven by a suitable computer 148 providing desired imagingfunctionality in cooperation with imaging apparatus 149. A typical imageof a section of the spinal region of the patient is illustrated atreference number 159.

In accordance with a preferred embodiment of the present invention, athree dimensional image file of the spinal region of the patient isbuilt up and stored in computer 148 and displayed via display 146. Thisthree-dimensional image file is preferably utilized to plan and carryout treatment of spinal disorders in accordance with a preferredembodiment of the present invention.

It is a feature of one embodiment of the present invention that thepatient position on support table 100 can be replicated with arelatively high degree of registration. This may be accomplished byemploying encoders at all joints between various support portions of thesupport table 100 and brace assemblies.

Thus, in accordance with one embodiment of the present invention,encoders 101 may be located in association with motors 113, and 118,(See FIG. 1) and at other appropriate locations. By reading theseencoders and using the readings in repositioning the patient, anacceptable level of registration may be achieved.

By using conventional imaging and computer image generation techniqueswith reference to a patient's spine as shown generally in FIG. 3, ahealthy spinal disc may be visualized as typically shown in FIG. 4A, apatient's diseased disc may be visualized as typically shown in FIG. 4Band a disc reconstructed in accordance with a preferred embodiment ofthe present invention may be visualized as typically shown in FIG. 4C.

Furthermore, in accordance with a preferred embodiment of the presentinvention a surgical approach path may be planned and visualized, aswill be described hereinbelow in detail, in order to avoid vital organs,nerves and blood vessels insofar as possible.

It is appreciated that the imaging and the operation may take place insufficiently close time proximity so as to enable the patient to remainbraced to the support table 100 for both procedures. Alternatively, thepatient may be removed from the support table 100 following imaging andthen rebraced thereto for the operation. In this alternative case, acertain amount of re-imaging becomes necessary to establish registrationof the image file with the current positioning of the patient.

There is provided a multi-functional surgical assembly constructed andoperative in accordance with a preferred embodiment of the presentinvention which is useful in carrying out treatment of spinal disordersin accordance with preferred embodiments of the present invention whichwill be described in detail hereinbelow. The multi-functional surgicalassembly will now be described:

Reference is now made to FIG. 5, which illustrates in a partial blockdiagram format, partial pictorial format, the system architecture of apreferred embodiment of a multi-functional surgical assembly constructedand operative in accordance with the present invention. It isappreciated that the multifunctional surgical assembly may be used notonly in endosurgery but also in open surgery.

The multi-functional surgical assembly includes a universal mountingassembly 160 which is preferably secured to and supported by theequipment support base 130, which is in turn fixed to the patient and toa patient support table 100 preferably in a manner described above andillustrated in FIG. 1. Universal mounting assembly 160 is describedhereinbelow with reference to FIGS. 6A, 6B & 7.

Replaceably and modularly mountable onto universal mounting assembly 160are first, second and third drive assemblies 162, 164 and 166, which aredescribed hereinbelow with reference to FIGS. 8A, 8B and 8Crespectively. A multi-functional cannula assembly 170, is operative inassociation with universal mounting assembly 160 and with first, secondand third drive assemblies 162, 164 and 166.

The multi-functional cannula assembly includes respective first, secondand third different cannula subassemblies 172, 174 and 176 which aredriven by respective first, second and third drive assemblies 162, 164and 166 in association with staging assemblies 178. The first, secondand third drive assemblies 162, 164 and 166 are operated by variouscontrollers, collectively designated by reference numeral 180.

The multi-functional cannula assembly 170 is described hereinbelow andillustrated generally in FIGS. 9-19. An operator interface 182 isemployed by an operator to control the operation of the remainder of theapparatus of FIG. 5. The operator is preferably a surgeon but, subjectto relevant laws and regulations, may be someone other than a surgeon.The terms “operator” and “sugeon” are therefore used interchangeablythroughout the specification.

Operator interface 182 preferably comprises a suitably-programmed highend computer, such as a Silicon Graphics workstation, which is connectedvia a network to computer 148 (FIG. 2) and to various other computersand peripherals useful in carrying out the operation.

Reference is now made to FIGS. 6A and 6B, which illustrate a preferredembodiment of universal mounting assembly 160. Universal mountingassembly 160 preferably comprises mounting trap 190 and 192, which arepreferably removably attached to equipment support base 130 (FIG. 1). Acarriage assembly 194, defining platform mounting tracks 196 and 198, isarranged for selectable and fixable positioning on tracks 190 and 192 asby means of an electric motor 199.

A platform 200 is preferably arranged for selectable and fixablepositioning onto platform mounting tracks 196 and 198 of carriageassembly 194 as by means of an electric motor 201. Preferably a cannulamounting assembly 204 is associated with platform 200. Motors 199 and201 are preferably controlled by respective rotational drivingcontrollers 205 and 206.

In accordance with a preferred embodiment of the present invention,there is mounted on platform 200 a real-time imaging assembly 207. Realtime imaging assembly 207 preferably comprises an imaging platform 208,which is removably and securely mounted onto platform 200, as byfasteners 209. Preferably mounted onto imaging platform 208 are aplurality of imaging units 210, typically forming a stereoscopic MRIassembly.

Additionally or alternatively a location tracker assembly comprising aplurality of location tracker units 211, such as electromagnetictrackers used in helmet displays, may also be provided for tracking thelocation of various surgical elements, described hereinbelow, which areinserted into the body during the operation. Additionally oralternatively an ultrasonic imaging assembly, comprising a plurality ofultrasonic transceivers 212 may additionally be provided for monitoringthe progress of surgery.

Preferably, the various elements of the real time imaging assembly 207are coupled to computer 148 and to an operator visualization subsystemdescribed hereinbelow. Additionally in accordance with a preferredembodiment of the present invention there is provided an array 214 of RFreceiving antennas 215 which are used, as described hereinbelow withreference to FIG. 10B, for sensing the precise orientation and positionof the first cannula subassembly 172.

Reference is now made to FIG. 7, which is a simplified pictorialillustration taken in the direction indicated by arrow VII in FIG. 6A.FIG. 7 illustrates the ca mounting assembly 204, which preferablycomprises a base 216 which is preferably removably secured onto platform200. Alternatively cannula mounting assembly 204 may be fixed ontoplatform 200.

Base 216 preferably comprises an upstanding portion 217 and a protrudingportion 218. A spherical bearing 219 is preferably mounted ontoprotruding portion 218 as shown and includes a central aperture 220through which first, second and third different cannula subassemblies172, 174 and 176 (FIG. 5) may slidably extend. Preferably attached tospherical bearing 219 is a selectably orientatable socket 221 forremovably and replaceably receiving first, second and third driveassemblies 162, 164 and 166 (FIGS. 5, 8A, 8B & 8C).

There is also preferably mounted on base 216 a pressurized fluid source230 having a plurality of pressurized fluid sockets 232 and apressurized hydraulic fluid source 234 having a plurality of hydraulicfluid sockets 236.

The orientation of selectably orientatable socket 221 is selectablydetermined in three dimensions by a pair of pivotably mountedpositioning pistons 240 and 242. Piston 240 is pivotably mounted ontoupstanding portion 217 of base 216 preferably by means of a sphericalmounting bearing 244 and is attached to socket 221 preferably by meansof a spherical mounting bearing 246.

Piston 242 is pivotably mounted onto upstanding portion 217 of base 216preferably by means of a spherical mounting bearing 248, and is attachedto socket 221 preferably by means of a spherical mounting bearing 250.Pistons 240 and 242 are preferably operated by a hydraulic drivingcontroller 252.

In accordance with a preferred embodiment of the invention, the cannulamounting assembly 204 comprises a multi-functional controller 253 whichincludes a plurality of electric power sockets 254 and a plurality ofelectric control signal sockets 256. Sockets 254 and 256 may be locatedat any convenient location in cannula mounting assembly 204 and arepreferably mounted on upstanding portion 217, as shown.

Multifunctional controller 253 typically comprises a plurality ofindividual controllers or a single controller that can control aplurality of surgical vehicles, surgical hands and surgical tools whichare described hereinbelow. Multifunctional controller 253 typicallyreceives electric control and power inputs from the operator interface182 (FIG. 5).

In accordance with a preferred embodiment of the present invention,there exists a bi-directional information link between themultifunctional controller 253 and the various devices controlledthereby, such that at any given time, controller 253 is aware of theidentity and operational status of each of the devices controlledthereby, for optimal control of the operation thereof.

Reference is now made to FIGS. 8A, 8B and 8C, which illustrate first,second and third drive assemblies 162, 164 and 166, respectively. Firstdrive assembly 162, illustrated in FIG. 8A, preferably comprises ahousing 262 onto which is mounted a linear driving motor 264 which iscontrolled by a linear driving controller 266. Driving motor 264 ispreferably coupled to at least one driving roller 268, which drivinglyengages first cannula subassembly 172 for providing linear drivingthereof.

Also mounted on housing 262 is a rotational driving motor 270, which iscontrolled by a rotational driving controller 272. Rotational drivingmotor 270 is preferably coupled to gearing 274, which drivingly engagesfirst cannula subassembly 172 for providing rotational driving thereof.

Second drive assembly 164, illustrated in FIG. 8B, preferably comprisesa housing 275 onto which is mounted a linear driving motor 276 which iscontrolled by a linear driving controller 278. Driving motor 276 ispreferably coupled to at least one driving roller 279, which drivinglyengages second cannula subassembly 174 for providing linear drivingthereof.

Third drive assembly 166, illustrated in FIG. 8C, preferably comprises ahousing 280 onto which is mounted a linear driving motor 281 which iscontrolled by a linear driving controller 282. Driving motor 281 ispreferably coupled to at least one driving roller 283, which drivinglyengages third cannula subassembly 176 for providing linear drivingthereof.

Reference is now made to FIG. 9, which illustrates the multi-functionalcannula assembly 170 and its constituent first second and thirdsubassemblies 172, 174 and 176. It may be seen that the first, secondand third subassemblies 172, 174 and 176 are generally coaxial. Inoperation, each subassembly has a different function. As will bedescribed hereinbelow in detail, subassembly 172 is steerable to adesired location in the patient's anatomy.

Once subassembly 172 is properly positioned and anchored, the secondcannula subassembly 174 is inserted thereover. The second cannulasubassembly 174 has a larger cross-section than the first cannulasubassembly 172 and may be constituted of a plurality ofsub-sub-assemblies, each of larger cross-section than its predecessor.

Third cannula subassembly 176 is inserted over the second cannulasubassembly 174 and is employed to perform various surgical functions.

First cannula subassembly 172 preferably includes a central flexiblecore 290 located within a flexible outer tube 291, preferably formed byfilament winding of a composite material. The outer tube 291 alsocontains therewithin curvature control tendons 292 which may betensioned or compressed to effect desired curvature of the subassembly172. Located within tube 291 there are also preferably provided aflexible drill shaft 293 terminating in a anchor screw 294 and at leastone fiber optics link 295.

Second cannula subassembly 174 may or may not include a fiber opticslink 296. Third cannula subassembly 176 preferably includes tracks 297for transport of surgical equipment therealong to a surgical site in thepatient's anatomy and removal of body materials from the surgical site.

Preferably the third cannula subassembly 176 also includes at least oneelectrical power link 298, at least one fiber optics link 299 and mayalso include piping for liquid transport vacuum and gas pressure.Preferably, the third cannula subassembly 176 also includes a pluralityof curvature control tendons 300.

Reference is now made to FIGS. 10A and 10B, which illustrate firstcannula subassembly 172 and to FIGS. 11A, 11B, 11C and 11D whichillustrate various sections thereof indicated by lines XIA-XIA, XIB-XIB,XIC-XIC and XID-XID respectively.

As noted hereinabove with reference to FIG. 9, the first cannulasubassembly 172 includes an anchor screw 294 coupled to a flexible drillshaft 293. Preferably the anchor screw 294 is enclosed within a cover301 which is preferably formed of a material which is readily absorbedby the human body.

The flexible drill shaft 293 preferably is formed with a driving head302 having a Allen-type recess 303 formed therein. Drill shaft 293 ispreferably rotatably located within a bore 304 (FIG. 11A) formed withincore 290.

Tendons 292 are preferably slidably disposed within respective elongatebores 305 (FIG. 11D) preferably formed in core 290, which bores aredistributed about the circumference of the subassembly 172, as seenclearly in FIG. 11D. Preferably each of the tendons 292, typically atleast three in number, is anchored at a location indicated by referencenumeral 306, adjacent the forward end of the first cannula subassembly172 and is coupled at its opposite end to a driving structure 307.

Driving structures 307 are each preferably formed with externally facingrecesses 308 to enable them to be readily engaged by an external drivingmember for linear driving thereof in a push-pull manner for applyingtension or compression to the tendon fixed thereto. Driving structures307 are linearly slidably disposed in recesses 310 formed in core 290 atwindows 312 formed in outer tube 291. Reference is made in thisconnection to FIG. 11C, which illustrates a recess 308 in structure 307.

At least one fiber optics link 295 is preferably located in a suitablerecess or bore 314 formed in core 290 and extends to a optical sensor315, which may or may not be equipped with a lens or other opticaldevice. Preferably multiple optical sensors 315 and multiple fiberoptics links 295 are present for providing three-dimensional viewing.

Preferably at least one additional fiber optics link 295 may be employedfor illumination and may extend from an external light source (notshown) to an illuminator 316.

Additionally in accordance with a preferred embodiment of the invention,at least one electrical conductor 317, and preferably two suchconductors 317 are provided to supply electrical power to at least oneand preferably two electrical signal beacon transducer 318 which arepreferably sensible to one or more of the elements of the real timeimaging assembly 207 described hereinabove with reference to FIGS. 6Aand 6B. Beacon transduce 318 enable the precise location and orientationof the first cannula subassembly 172 to be ascertained and monitored.

In accordance with a preferred embodiment of the present invention anelongate low power RF transmitting antenna 319 is provided and receivesan electrical signal from any suitable RF signal source (not shown).Antenna 319 is provided such that its precise orientation may be readilysensed by antennas 215 of array 214 which preferably form part of thereal time imaging assembly 207 shown in FIG. 6B.

In accordance with a preferred embodiment of the present invention thevarious fiber optics links 295 are coupled to external optical devicesvia fiber optics connector elements 320. Additionally the variouselectrical conductors 317 may be coupled to external electronic devicesvia electrical connector elements 321. Antenna 319 may be connected toits RF signal source by means of a signal connector 322. Connectorelements 320, 321 and 322 may be covered by a removable cover element323.

At least one first subassembly mounting recess 324 is provided, as seenparticularly in FIG. 11B. It is appreciated that outer tube 291 isrecessed within a corresponding recess 325 formed in core 290.

In accordance with a preferred embodiment of the present invention, anelongate recess 326 may be formed along a majority of the length of thefirst cannula subassembly 172, as shown in FIG. 11D. This recess may beengaged by a suitable protrusion connected to gearing 274 (FIG. 8A) forrotational driving of the first cannula subassembly 172. It may also beengaged by a suitable protrusion forming part of the second cannulasubassembly 174, as will be described hereinbelow with reference to FIG.14.

Reference is now made to FIGS. 12A-12C which illustrate the structureand operation of a steering subassembly 330 which is useful inconnection with the first cannula subassembly 172 (FIGS. 10A & 10B).Steering subassembly 330 comprises a housing 350 onto which are mounteda drill driving assembly 352 and a tendon tensioning and compressingassembly 354. A fiber optic connector assembly 356 is also provided foroperational engagement with connector elements 320 once cover element323 has been removed (FIG. 10A).

Steering subassembly 330 preferably comprises a base member 360 which ispreferably removably mounted on housing 350 and which supports fiberoptic connector assembly 356. A drill driving motor 362 is supported,preferably by means of a peripheral support element 364, onto basemember 360 and includes a drive shaft 366 which engages recess 303 offlexible shaft 293 (FIGS. 10A and 10B). Drill driving motor 362 ispreferably controlled by a rotational driving controller 367.

Tendon tensioning and compressing assembly 354 preferably comprises aplurality of pistons 368, corresponding in number to the number oftendons 292 in the first cannula subassembly. Each of the pistons 368 ismounted onto housing 350 and includes a preferably at least partiallyflexible toothed shaft 370 which is arranged to operatively engagerecesses 308 in driving structures 307 for producing linear displacementthereof in recesses 310 for selectably tensioning or compressing theindividual tendons 292 attached to each of the driving structures 307.Pistons 368 are preferably controlled by an hydraulic controller 371.

FIG. 12A illustrates the flexible toothed shafts 370 in a nominal linearposition in engagement with recesses 308 of driving structures 307. Thisengagement is produced by means of a slidable biasing element 372 which,when located in a first longitudinal position engages flexible toothedshafts 370 and forces them inwardly into toothed engagement withrecesses 308.

FIG. 12B shows the flexible toothed shafts 370 when slidable biasingelement 372 is located in a second longitudinal position whereby it doesnot force flexible shafts 370 into engagement with recesses 308. Thislatter orientation occurs during engagement and disengagement of thesteering subassembly 330 with the first cannula subassembly 172.

FIG. 12C illustrates selectable extension and retraction of individualpistons 368 from their nominal positions, thus producing lineardisplacement of driving structures 307, as indicated by arrows 374 and376, resulting in corresponding tensioning and compressing of tendons292 for producing desired curvature of the first flexible cannulasubassembly 172.

Reference is now made to FIGS. 13 and 14, which are simplified sectionalillustrations of the second cannula subassembly 174, forming part of themulti-functional cannula assembly of FIG. 9. The second cannulasubassembly 174 is a generally flexible, generally cylindrical elementhaving a cross-sectional configuration typically of the type shown inFIG. 14.

The second cannula subassembly typically has an inner surface 400 ofgenerally circular cross-section, just slightly larger than the outerdimensions of the first cannula subassembly 172 and is arranged to beslidable thereover. Inner surface 400 preferably has an inner facingprotrusion 402 which is arranged to engage corresponding recess 326(FIG. 11D).

Preferably, adjacent the rearward end of the second cannula subassemblythere is provided a conditioned easily grippable surface 404 to enhanceease of manipulation of the second cannula subassembly. Preferably,fiber optics connectors 406 are provided at the rearward end of thesecond cannula subassembly for fiber optics communication connectionsbetween fiber optics links 296 which communicate with optical sensors408 and illuminators 410.

Reference is now made additionally to FIGS. 15A and 15B, which aresimplified illustrations showing engagement between the first and secondcannula subassemblies in accordance with a preferred embodiment of thepresent invention.

Adjacent the rearward end of the second cannula subassembly 174 there isprovided a slider 420 preferably having a manual engagement portion 421and a generally flat portion 422 having a forward end 423. Slider 420 isslidably retained in second cannula subassembly 174 for longitudinalsliding motion relative thereto, into and out of operative engagementwith a flexible engagement member 424.

Flexible engagement member 424, which is typically formed of a resilientmaterial, such as flexible, resilient plastic, includes a mountingportion 426 which is seated in a recess 427 formed in the second cannulasubassembly 174, an elongate portion 428 and an inner facing protrusionportion 430. Flexible engagement member 424 is mounted such that it isbiased inwardly into engagement into recess 324 (See also FIGS. 10A and10B) in the first cannula subassembly, when not displaced by the slider420.

FIG. 15A illustrates engagement member 424 in a non-engaged orientation,wherein slider 420 is in a forward orientation and retains theengagement member 424 out of engagement with recess 324. FIG. 15Billustrates engagement member 424 in engagement with recess 324,inasmuch as slider 420 is in a retracted orientation.

The orientation shown in FIG. 15B provides linear and rotationalcoupling between the first and second cannula subassemblies, while theorientation shown in FIG. 15A permits relative rotational and linearmovement therebetween.

Reference is now made to FIG. 16, which is a simplified pictorialillustration of third cannula subassembly 176, forming part of themulti-functional cannula assembly of FIG. 9, and to FIG. 17, which is asimplified sectional illustration taken along plane XVII of FIG. 16illustrating mutually slidable inner and outer portions of the thirdcannula subassembly.

The third cannula subassembly 176 (FIG. 5) preferably comprises an outerportion 500 having a forward edge 501 and an inner portion 502 having aforward edge 503, the outer portion 500 being selectably slidable withrespect to the inner portion 502.

The outer portion 500 is a generally cylindrical hollow element ofgenerally oval cross-section and is formed with a plurality of tracks297 (FIG. 9), preferably including a first plurality, typically four,inner facing tracks 504, shown clearly in FIG. 17, each preferablyhaving an undercut cross-section, which are directed inwardly generallyat diagonals of the cross-section of the outer portion.

In addition, there are preferably provided a second plurality, typicallytwo, inner facing tracks 506, preferably having a configurationdifferent from that of tracks 504 and also preferably having an undercutcross-section. Tracks 506 are directed inwardly generally at a midpointof the length of the cross-section of the outer portion 500.

Furthermore, there are preferably provided a third plurality, typicallytwo, of inner facing tracks 508, preferably having a configurationdifferent from that of tracks 504 and 506 and also preferably having anundercut cross-section. Tracks 508 are directed inwardly generally at amidpoint of the width of the cross-section of the outer portion 500.

At least two and preferably all of tracks 504 are formed with elongatebores 510 extending therethrough and preferably being of circularcross-section.

At least two and preferably all of tracks 506 are formed with elongatebores 512 extending therethrough and preferably being of circularcross-section.

At least two and preferably all of tracks 508 are formed with a pair ofelongate bores 514 and 516 extending therethrough and preferably beingof circular cross-section.

Disposed in at least two of elongate bores 510 are anchoring screws 520,each having a tapered thread 522 at its forward end and an engagementhead 524 at its opposite end. Engagement head 524 may have any suitableconfiguration, such as a female Allen wrench socket 526, to enable theanchoring screws 520 to be selectably rotated and thus driven intoanchoring engagement with a vertebra of a patient by manual or motorizeddriving apparatus.

Disposed in at least one and preferably both of elongate bores 516 areelongate eye assemblies 530, the structure and operation of which aredescribed hereinbelow with reference to FIGS. 21 and 22. Eye assemblies530, each comprise a visual sensor 532, such as a CCD sensor, preferablysurrounding an illuminator 533.

Sensor 532 is preferably coupled via a fiber optic fink embedded in anelongate eye manipulating support 534 to utilization circuitry (notshown). Manipulating support 534 is, in turn, operated by a driveassembly 536, preferably mounted on an outer flange 537 of outer portion500, and an eye directing assembly 538 and is preferably capable oflinear displacement and rotation relative to bore 516 as well asdirectable bending.

Optionally disposed in bores 512 and 514 there are provided a total offour tendons 540, which may be employed for providing selectablebendability and directability to the third cannula subassembly 176.Alternatively, third cannula subassembly 176 may be non-directable. Insuch a case, tendons 540 may be omitted.

Each of tendons 540 may be operated by a steering subassembly 542, whichmay be similar in all relevant respects of its structure and operationto steering subassembly 330, which is described hereinabove in detailwith reference to FIGS. 12A-12C and which is typically, controlled by anhydraulic controller 543.

The inner portion 502 of the third cannula subassembly 176 functionsprincipally as a spacer for properly positioning the outer portion 500with respect to the second cannula subassembly. As will be describedhereinbelow, the inner portion 502 is preferably removed prior tocarrying out most of the functionality of the outer portion 500.

Preferably fiber optics connectors 556 are provided at the rearward endof the third cannula subassembly for fiber optics communicationconnections between fiber optics links 558 and 560 which communicatewith optical sensors 562 and illuminators 564 respectively.

Reference is now made additionally to FIGS. 18A and 18B, which aresimplified illustrations showing engagement between the second and thirdcannula subassemblies 174 and 176 respectively in accordance with apreferred embodiment of the present invention.

Adjacent the rearward end of the third cannula subassembly 176 there isprovided a slider 565 preferably having a manual engagement portion 566and a generally flat portion 567 having a forward end 568. Slider 565 isslidably retained in third cannula subassembly 176 for longitudinalsliding motion relative thereto, into and out of operative engagementwith a flexible engagement member 569.

Flexible engagement member 569, which is typically formed of a resilientmaterial such as flexible, resilient plastic, includes a mountingportion 570 which is seated in a recess 571 formed in inner portion 502of the third cannula subassembly 176, an elongate portion 572 and aninner facing protrusion portion 57T extending therefrom. Flexibleengagement member 569 is mounted such that it is biased inwardly intoengagement with a recess 574 in the second cannula subassembly, when notdisplace by the slider 565.

FIG. 18A illustrates engagement member 569 in a non-engaged orientation,wherein slider 565 is in a forward orientation and retains theengagement member 569 out of engagement with recess 574. FIG. 18Billustrates engagement member 569 in engagement with recess 574,inasmuch as slider 565 is in a retracted orientation.

The orientation shown in FIG. 18B provides linear and rotationalcoupling between the second and third cannula subassemblies, while theorientation shown in FIG. 18A permits relative rotational and linearmovement therebetween.

A locking pin 575 associated with outer portion 500 selectably engages arecess 576 formed in inner portion 502 for preventing linear motiontherebetween prior to intended removal of the inner portion 502 from theouter portion 500.

Reference is now made to FIG. 19, which is a simplified enlargedillustration of part of the third cannula subassembly 176 of FIG. 16including drive assembly 536 and eye directing assembly 538. Driveassembly 536 preferably comprises a housing 577 onto which is mounted alinear driving motor 578 which is controlled by a linear drivingcontroller 579. Driving motor 578 is preferably coupled to at least onedriving roller 580, which drivingly engages eye manipulating support534.

Also mounted on housing 577 is a rotational driving motor 581, which iscontrolled by a rotational driving controller 582. Rotational drivingmotor 581 is preferably coupled to gearing 584, which drivingly engageseye manipulating support 534 for providing rotational driving thereof.

In accordance with a preferred embodiment of the present invention thereis provided in housing 577, a recess 585 which cooperates with amanually manipulatable screw 586. Housing 577 is arranged for removable,selectably positionable, secure mounting in a recess 587 formed on outerportion 500 of the third cannula subassembly 176.

FIG. 19 illustrates that eye manipulating support 534 engages bore 516(FIG. 17) in outer portion 500.

Eye directing assembly 538 comprises a housing 590 onto which aremounted a tendon tensioning and compressing assembly 592. A fiber opticconnector assembly 594 may also be provided for operational engagementof sensors 532 and illuminators 533 with an operator visualizationsubsystem, described hereinbelow with respect to FIG. 34. Eye directingassembly 538 preferably comprises a base member 596 which is preferablyremovably mounted on housing 590 and which supports fiber opticconnector assembly 594.

Additional eye assemblies, eye manipulating supports, drive assemblies,and eye directing assemblies, which may be identical to respective eyeassembly 530, eye manipulating support 534, drive assembly 536 and eyedirecting assembly 538 may be provided for use with various surgicalvehicles as described hereinbelow with reference to FIGS. 23A-25.

The outputs of the eye assemblies may be coupled by suitably locatedconnectors, such as connector assembly 594 to the operator visualizationsubsystem. One such eye manipulating support is indicated in FIG. 19 byreference numeral 597.

Tendon tensioning and compressing assembly 592 preferably comprises aplurality of pistons 598, corresponding in number to the number oftendons 600 in the eye directing assembly 538. Each of the pistons 598is mounted onto housing 590 and includes a preferably at least partiallyflexible toothed shaft 602 which is arranged to operatively engagerecesses in driving structures 606 for producing linear displacementthereof for selectably tensioning or compressing the individual tendons600 attached to each of the driving structures 606. Pistons 598 arepreferably controlled by a hydraulic controller 607.

It is appreciated that eye directing assembly 538 may be constructed andoperative in a manner similar in most relevant respects to steeringsubassembly 330, which is described in detailed hereinabove withreference to FIGS. 11C and 12A-12C.

Reference is now made to FIG. 20, which is a simplified pictorialillustration of the operation of elongate eye assemblies 530 (FIG. 16)in a spinal environment.

It is seen that the eye manipulating supports 534 on which are mountedthe visual sensors 532, may be extended and retracted along axesindicated by arrows 620, may be rotated about such axes, as indicated byarrows 622 and may be bent for selectable viewing, as indicated byarrows 624. Thus the elongate eye assemblies 530 may provide an operatorwith selectable views of the operating environment.

In FIG. 20, the illustrated operating environment is the space betweentwo adjacent vertebrae, wherein the disc therebetween has been removed.

FIG. 21 is a simplified illustration showing a view of the operatingenvironment provided to an operator by the portion of the third cannulasubassembly 176 shown in FIG. 16, showing end plates 2024, 2025 of bothadjacent vertebrae 2004, 2005, as well as a prosthetic component 2024placed therebetween in accordance with an embodiment of the presentinvention as will be described hereinbelow.

It is a particular feature of the present invention that the operator isprovided with a view of the operating environment as if he were presentat the visual sensor. This view can be enhanced by the use of virtualreality output devices which are conventionally available.

Reference is now made to FIG. 22, which is a simplified pictorialillusion of a portion of the third cannula subassembly of FIGS. 16 and17 containing three self-propelled surgical vehicles constructed andoperative in accordance with a preferred embodiment of the presentinvention and to FIGS. 23A-25B which illustrate the variousself-propelled surgical vehicles.

Disposed on any two mutually diagonally positioned inner facing tracks504 is a first self-propelled surgical vehicle 700, which is shownparticularly in FIGS. 23A and 23B, operative in cooperation with thethird cannula subassembly 176 in accordance with a preferred embodimentof the present invention.

Vehicle 700 comprises a body 702 of generally uniform cross-sectionhaving a longitudinal bore 704 and defining forward and rearward faces706 and 708. A quick connection mounting assembly 710, typically of thebayonet type, is provided at bore 704, preferably at both faces 706 and708.

Preferably, at least the forward face 706 of the body 702 is formed witha plurality of recesses 712, 714, 716 and 718 which are employed forassist in the mounting of hands onto the vehicle 700. A preferred typeof band is described hereinbelow with reference to FIG. 27.

Body 702 is preferably formed with a pair of longitudinal recesses 720and 722 which extend along edges of the body in parallel to bore 704.Disposed along longitudinal recess 720 there are provided at least twofreely rolling rollers 724. Preferably disposed along longitudinalrecess 722 there is a driving roller 726, which is preferably powered byan electric motor 728, disposed within body 702.

Typically rollers 724 roll along one of tracks 504, while driving roller726 drivingly engages cogs (not shown) on a track 504 for precisionlongitudinal positioning of the vehicle along tracks 504. Electric motor728 is preferably controlled by multi-functional controller 253 (FIG. 7)via a control cable 729, which extends through the outer portion 500 ofthe third cannula subassembly 176 and is preferably connected to one ofcontrol signal sockets 256 of multi-functional controller 253.

Electric motor 728 preferably receives electrical power frommulti-functional controller 253 (FIG. 7) via a power cable 730 extendingfrom an electric power socket 254 and which is removably coupled to asocket 732 formed on rearward face 708.

Preferably auxiliary electrical power is provided for hands attached tothe forward face 706 by means of an auxiliary power cable 734 which isremovably coupled to a socket 736 formed on rearward face 708. Cable 734typically extends through longitudinal bore 704.

Preferably auxiliary electrical control is provided for hands attachedto the forward face 706 by means of an auxiliary control cable 737 whichis removably coupled to a socket 738 formed on rearward face 708. Cable737 typically extends through longitudinal bore 704.

Preferably auxiliary electrical control is provided to socket 738 forhands attached to the forward face 706 by means of an auxiliary controlcable 739 which is removably coupled to a socket 740 formed on rearwardface 708 and extends through the outer portion 500 of the third cannulasubassembly 176 and is preferably connected to one of control signalsockets 256 of multi-functional controller 253.

It is appreciated that the largest cross-sectional dimension of vehicle700 is preferably less than 20 mm.

In accordance with a preferred embodiment of the invention body 702 isformed with a throughgoing bore 742 for accommodating eye manipulatingsupport 534 (FIG. 19).

Reference is now additionally made in particular to FIGS. 24A and 24B,which are pictorial illustrations of a second self-propelled surgicalvehicle 750 operative in cooperation with the third cannula subassemblyin accordance with a preferred embodiment of the present invention.

Vehicle 750 is disposed on any one of inner-facing tracks 504 and alsoslides along at least one of tracks 506 and 508 (FIG. 17). Vehicle 750comprises a body 752 of generally uniform cross-section having alongitudinal bore 754 and defining forward and rearward faces 756 and758. Quick connectors 760, typically of the bayonet type, are providedperipherally of bore 754, preferably at both aces 756 and 758.

Preferably, at least the forward face 756 of the body 752 is formed witha plurality of throughgoing bores 762 and 764, which are employed topermit various power and control cables to extend therethrough.

Body 752 is preferably formed with a pair of longitudinal recesses 770and 772 which extend along side surfaces of the body in parallel to bore754 and which preferably engage tracks 508 and 506 (FIG. 17)respectively. Body 752 additionally comprises a third longitudinalrecess 773 along which there are provided at least one freely roilingroller 774 and a driving roller 776, which is preferably powered by anelectric motor 778, disposed within body 752.

Preferably longitudinal recess 773 of body 752 is formed at its endswith a cross-sectional configuration defining an undercut 777 whichmaintains operative engagement between the rollers 774 and 776 and thetack 504 and thus enables vehicle 750 to ride on a single track 504.Typically roller 774 rolls along track 504; while driving roller 776drivingly engages cogs on track 504 for precision longitudinalpositioning of the vehicle 750 along track 504.

Electric motor 778 is preferably controlled by multi-functionalcontroller 253 (FIG. 7) via a control cable 779, which extends throughthe outer portion 500 of the third cannula subassembly 176 and ispreferably connected to one of control signal sockets 256 ofmulti-functional controller 253.

Similarly to the construction of vehicle 700, electric motor 778preferably receives electrical power via a cable 780 which is removablycoupled to a socket 781 formed on rearward face 758. Preferablyauxiliary electrical power is provided for hands attached to the forwardface 756 by means of an auxiliary power cable 782 which is removablycoupled to a socket 783 formed on rearward face 758 and which typicallyextends through longitudinal bore 764.

Preferably auxiliary electrical control is provided for hands attachedto the forward face 756 by means of an auxiliary control cable 784 whichis removably coupled to a socket 785 formed on rearward face 758. Thecable typically extends through longitudinal bore 762.

Preferably auxiliary electrical control is provided to socket 785 onrearward face 758 for hands attached to the forward face 756 by means ofan auxiliary control cable 786 which is removably coupled to a socket787 formed on rearward face 758 and extends through the outer portion500 of the third cannula subassembly 176 and is preferably connected toone of control signal sockets 256 of multi-functional controller 253.

It is appreciated that the largest cross-sectional dimension of vehicle750 is preferably less than 16 mm.

Power cable 780 extends through the outer portion 500 of the thirdcannula subassembly 176 and is preferably connected to one of electricpower sockets 254 of multi-functional controller 253 (FIG. 7).

In accordance with a preferred embodiment of the invention, body 752 isformed with a throughgoing bore 788 for accommodating eye manipulatingsupport 534 (FIG. 19).

Reference is now additionally made in particular to FIGS. 25A and 25B,which are pictorial illustrations of a third self-propelled surgicalvehicle 800 operative in cooperation with the third cannula subassemblyin accordance with a preferred embodiment of the present invention.

Vehicle 800 is disposed on any one of inner-facing tracks 504 and alsoslides on at least one ridge 801 along at least one inner surface ofouter portion 500 of the third cannula subassembly FIG. 17). Vehicle 800comprises a body 802 of generally uniform cross-section having alongitudinal recess 804 and defining forward and rearward faces 806 and808. Quick connectors 810, typically of the bayonet type, are providedperipherally of recess 804.

Preferably, at least the forward face 806 of the body 802 is formed witha plurality of bores 812 and 814, which are employed for allowing powerand control cables to end therethrough.

Body 802 is preferably formed with a longitudinal recess 823 along whichthere are provided at least one freely rolling roller 824 and a drivingroller 826, which is preferably powered by an electric motor 828,disposed within body 802.

Preferably longitudinal recess 823 of body 802 is formed at its endswith a cross-sectional configuration defining an undercut 827 whichmaintains operative engagement between the rollers 824 and 826 and thetrack 504 and thus enables vehicle 800 to ride on a single track 504.Typically roller 824 rolls along ta 504, while driving roller 826drivingly engages cogs on track 504 for precision longitudinalpositioning of the vehicle 800 along track 504.

Electric motor 828 is preferably controlled by multi-functionalcontroller 253 (FIG. 7) via a control cable 829, which extends throughthe outer portion 500 of the third cannula subassembly 176 and ispreferably connected to one of control signal socket 256 ofmulti-functional controller 253.

Similarly to the construction of vehicles 700 and 750, electric motor828 preferably receives electrical power via a cable 830 which isremovably coupled to a socket 831 formed on rearward face 808.Preferably auxiliary electrical power is provided, for hands attached tothe forward face 806, by means of an auxiliary power cable 832 which isremovably coupled to a socket 833 formed on rearward face 808 and whichtypically extends through longitudinal bore 812.

Preferably auxiliary electrical control is provided, for hands attachedto the forward face 806, by means of an auxiliary control cable 834which is removably coupled to a socket 835 formed on reward face 808.The cable typically extends through longitudinal bore 814 to the forwardface 806.

Preferably auxiliary electrical control is provided to the rearward face808 for the control cable 834 by means of a second auxiliary controlcable 836 which is removably coupled to a socket 837 formed on rearwardface 808. The socket 837 is connected internally to socket 835. Thesecond auxiliary control cable extends through the outer portion 500 ofthe third cannula subassembly 176, and is preferably connected to acontrol signal socket 256 of multifunctional controller 253. Thusauxiliary electrical control is passed from the signal socket 256 to thehands mounted on the forward face 806.

It is appreciated that the largest cross-sectional dimension of vehicle800 is preferably less than 10 mm.

Power cable 830 extends through the outer portion 500 of the thirdcannula subassembly 176 and is preferably connected to one of electricpower sockets 254 of multi-functional controller 253 (FIG. 7).

In accordance with a preferred embodiment of the invention, body 802 isformed with a throughgoing bore 842 for accommodating eye manipulatingsupport 534 (FIG. 19).

Reference is now made to FIG. 26, which is a simplified pictorialillustration of a portion of the third cannula subassembly of FIGS. 16and 17 containing three non self-propelled surgical vehicles 850constructed and operative in accordance with a preferred embodiment ofthe present invention.

Vehicles 850, which may have differing configurations or dimensions ormay be identical to each other, are typically elongate flexible elementshaving a forward face 852 and a rearward face 854 and a generallyuniform cross-sectional configuration including an undercut 857 whichmaintains operative engagement between the vehicles and the track 504.

Vehicles 850 may be translated along tracks 504 manually oralternatively by any suitable driving mechanism, such as, for example,an electric motor 860 engaging a rack 862 formed on a portion of thevehicle. Motor 860 is preferably mounted onto a motor support platform,not shown, which may be removably associated with the outer portion 500of the third cannula subassembly 176 or with a staging assembly 178.

As a further alternative, one or more vehicles 850 may be self-propelledby virtue of an electric motor 870 being mounted on board the vehicleand engaging cogs on track 504. Electric motors 860 and 870 arepreferably controlled by multi-functional controller 253 (FIG. 7) viarespective control cables 871 and 872, which extend through the outerportion 500 of the third cannula subassembly 176 and are preferablyconnected to control signal socket 256 of multi-functional controller253.

Preferably there are provided on at least one elongate surface 873 ofeach vehicle 850 one or more quick connectors 874 for connection theretoof hands (not shown) for use with vehicles 850.

Similarly to the construction of vehicles 700 and 750, electric motors860 and 870 preferably receive electrical power via respective cables875 and 876. Power cables 875 and 876 are preferably connected torespective electric power sockets 254 of multifunctional controller 253(FIG. 7).

Preferably auxiliary electrical control is provided for hands attachedto a forward portion of elongate surface 873 by means of auxiliarycontrol cables (not shown) which are removably coupled to sockets (notshown) formed on rearward face 854. The cables typically extend throughan internal bore (not shown).

Preferably auxiliary electrical control is provided to the aforesaidsockets on rearward face 854 for hands attached to connectors 874 bymeans of auxiliary control cables 879 and 880 which are removablycoupled to sockets 882 and 884 formed on rearward face 854 and whichextend through the outer portion 500 of third cannula subassembly 176and are preferably connected to respective control signal socket 256 ofmulti-functional controller 253.

Reference is now made to FIG. 27, which illustrates a universal hand 900which is preferably employed in association with surgical vehicle 700.Universal hand 900 typically comprises a base 902 which may be removablycoupled to a surgical vehicle, typically via a quick connector.

Rotatably mounted with respect to base 902 for rotation about alongitudinal axis 904 is a first intermediate element 906. The rotationof first intermediate element 906 relative to base 902 aboutlongitudinal axis 904 is governed preferably by an electric motor 908,which is typically located in first intermediate element 906.

Rotatably mounted with respect to first intermediate element 906 forrotation about a first transverse axis 910, typically perpendicular tolongitudinal axis 904, is a second intermediate element 912. Therotation of second intermediate element 912 relative to firstintermediate element 906 about transverse axis 910 is governedpreferably by an electric motor 914, which is typically located insecond intermediate element 912.

Rotatably mounted with respect to second intermediate element 912 forrotation about a second transverse axis 916, typically perpendicular tofirst transverse axis 910, is a third intermediate element 918. Therotation of third intermediate element 918 relative to secondintermediate element 912 about second transverse axis 916 is governedpreferably by an electric motor 920, which is typically located in thirdintermediate element 918.

Rotatably mounted with respect to third intermediate element 918 forrotation about an axis 922, typically perpendicular to second transverseaxis 916, is a fourth intermediate element 924. The rotation of fourthintermediate element 924 relative to third intermediate element 918about axis 922 is governed preferably by an electric motor 926, which istypically located in fourth intermediate element 924.

Fixedly mounted on fourth intermediate element 924 there is preferablyformed a tool engagement element 930, such as a bayonet connection.

It is appreciated that universal hand 900 may be employed in associationwith surgical vehicle 700 but also may be advantageously employed on oneor more surgical vehicles 750, 800 and 850. It is appreciated that whensurgical vehicles 750, 800 and 850, each of which moves along a singletrack 504, are used, there exists the possibility that up to fouruniversal hands 900 may be employed simultaneously without mutualinterference, thereby to provide the functionality of up to fourfingers.

It is also appreciated that the universal hand may be provided in anumber of different sizes and may also be provided with any desirednumber of intermediate elements.

FIGS. 28A, 28B, 28C, 28D & 28E are pictorial illustrations of millingheads which are employed in association with the surgical vehicles shownin FIGS. 23A-26 and preferably mounted on various types of tools, suchas those described hereinbelow and illustrated in FIGS. 29A & 29B.

FIG. 28A illustrates a milling head 1002 having a rounded tip 1004. FIG.28B illustrates a milling head 1012 having a short cylindrical tip 1014.FIG. 28C illustrates a milling head 1022 having a planar tip 1024. FIG.28D illustrates a milling head 1032 having a conical tip 1034. FIG. 28Eillustrates a milling head 1042 having an inverted conical tip 1044.

Reference is now made to FIGS. 29A and 29B, which illustrate twoalternative embodiments of a milling tool respectively designated byreference numerals 1300 and 1301. Milling tools 1300 and 1301 aretypically identical other than in the location of a milling head socketthereon.

In milling tool 1300, a milling head socket 1302 is located in a planegenerally perpendicular to that of a mounting socket 1303, which isadapted for removable mounting on tool engagement element 930 ofuniversal hand 900 (FIG. 27). Milling tool 1300 preferably includes anelectric motor 1304 which drives milling head socket 1302.

In milling tool 1301, a milling head socket 1305 is located in a planegenerally parallel to that of a mounting socket 1306, which is adaptedfor removable mounting on tool engagement element 930 of universal hand900 (FIG. 27). Milling tool 1301 preferably includes an electric motor1307 which drives milling head socket 1305.

It is appreciated that in accordance with a preferred embodiment of thepresent invention various milling heads may be replaceably and modularlymountable on milling head sockets 1302 and 1305. A selection of suitablealternative milling heads is described above in FIGS. 28A-28E.Alternatively, any other suitable milling heads may be employed.

Reference is now made to FIG. 29C, which illustrates a forceps tool 1313which may be employed in association with universal hand 900 andremovably and replaceably coupled to tool engagement element 930 thereof(FIG. 27). Forceps tool 1313 typically comprises a base 1314 onto whichis preferably fixedly mounted a first forceps finger 1315.

A second forceps finger 1316 is mounted for selectable positioning withrespect to forceps finger 1315, such as in an off-axis arrangement on adrive shaft 1317 of a motor 1318 which may be controlled directly bymulti-functional controller 253 (FIG. 7).

Reference is now made to FIG. 29D, which illustrates a dispenser tool1319 which may be employed in association with universal hand 900 andremovably and replaceably coupled to tool engagement element 930 thereof(FIG. 27). Dispenser tool 1319 receives a poetized fluid input via aflexible fluid supply tube 1320 from a prized fluid source (not shown)typically located outside the patient and provides a desired supply offluid via an output nozzle 1321.

Reference is now made to FIG. 29E, which illustrates a pick and placetool which may be employed in association with universal hand 900 andremovably and replaceably coupled to tool engagement element 930 thereof(FIG. 27).

In accordance with one preferred embodiment of the present invention,the pick and place tool, indicated at reference numeral 1322, is a rigidelement. Both left and right engagement elements may be provided.Protrusions 1323 may be provided on tool 1322 in a predeterminedarrangement which mates sockets on an implant (not shown) to bemanipulated thereby.

According to another preferred embodiment of the present invention, theengagement element may be an articulated element, as indicated byreference numeral 1324, including a base portion 1325 which is rotatablycoupled to an intermediate portion 1326, which is, in turn rotatablycoupled to an end portion 1327.

An electric motor 1336 governs the relative orientations of intermediateportion 1326 and base portion 1325, while an electric motor 1338 governsthe relative orientations of end portion 1327 and intermediate portion1326. It is appreciated that by suitable operation of electric motors1336 and 1338, the engagement element 1324 may be a right or leftengagement element, having desired curvature.

It is appreciated that various protrusions 1340, 1342 and 1344 may beprovided on base portion 1325, intermediate portion 1326 and end portion1327 in a predetermined arrangement which matches sockets on an implant(not shown) to be manipulated thereby.

Reference is now made to FIG. 29F, which illustrate an inflation tool1350 which may be employed in association with universal hand 900 andremovably and replaceably coupled to tool engagement element 930 thereof(FIG. 27). The inflation tool 1350 typically comprises a pressurizedfluid supply inlet tube 1352 which is adapted to be connected to apressurized fluid socket 232 (FIG. 7) and a pressurized fluid connectortube 1354 which is adapted to engage a fluid valve in the inflatableimplant described hereinbelow with reference to FIG. 53B.

Reference is now made to FIG. 29G, which illustrate a gauging tool 1360which may be employed in association with universal hand 900 andremovably and replaceably coupled to tool engagement element 930 thereof(FIG. 27). The gauging tool 1360 typically comprises a fixed firstgauging finger 1362 and a rotatably mounted second gauging finger 1364,which is preferably spring biased relative to first gauging finger 1362and thereby urged in a direction indicated by an arrow 1366 to a maximumrotational opening relative thereto.

Preferably a potentiometer 1368 or any other stable electronic sensor,senses the relative rotational positions of fingers 1362 and 1364 andthus provides an electronic output indication of the spatial separationof respective tips 1372 and 1374 thereof preferably via a mountingsocket 1376 formed on a base 1378 of the gauging tool.

Reference is now made to FIG. 291, which illustrates a cutting tool 1380which may be employed in association with universal hand 900 andremovably and replaceably coupled to tool engagement element 930 thereof(FIG. 27). Cutting tool 1380 typically comprises a base 1382 onto whichis preferably fixedly mounted one cut finger 1384.

A second cutter finger 1386 is mounted for selectable positioning withrespect to cutter finger 1384, such as in an off-axis arrangement on adrive shaft 1388 of a motor 1390 which may be controlled directly bymulti-functional controller 253 (FIG. 7). Formed on respective extremeouter ends 1392 and 1394 of cutter fingers 1384 and 1386 are hookedcutting blades 1396 and 1398 respectively.

Reference is now made to FIGS. 30A-30C and FIG. 31A and FIG. 31B, whichillustrate a staging assembly 1450 useful in setting up and connectingtools and hands together with surgical vehicles as required to carry outvarious functions in the operation. Staging assembly 1450 is onepreferred embodiment of the staging assemblies 178 described hereinabovewith reference to FIG. 5.

As seen clearly in FIGS. 30A-30C and FIG. 31A and FIG. 31B, the stagingassembly preferably comprises a pair of end mounts 1452, typically ofgenerally open octagonal configuration, which are fixedly joinedtogether by an elongate base element 1454, which defines an inner facingsurgical vehicle support track 1456, which is preferably alignable witha tank 506 in the third cannula subassembly 176.

End mounts 1452 each preferably define seats 1458, 1460 and 1462 forremovably and securably receiving respective inner facing surgicalvehicle support track defining members 1464, 1466 and 1468.

Inner facing surgical vehicle support tack defining member 1464 ispreferably alignable with a track 506 in the third cannula subassembly176. Inner facing surgical vehicle support track defining members 1466are preferably alignable with tracks 504 in the third cannulasubassembly 176. Inner facing surgical vehicle support tack definingmembers 1468 are preferably alignable with tracks 508 in the thirdcannula subassembly 176.

Retaining pins 1470 are preferably provided for removable engagementwith sockets 1472 formed in at least one of end mounts 1452 forengagement with corresponding sockets 1473 formed in ends of the varioussupport track defining members are shown, thereby to retain the tackdefining members in engagement with their respective seats.

In accordance with a preferred embodiment of the invention, one of endmounts 1452 is provided with an inner socket 1474 which is configured toreceive flange 537 (FIG. 16) of outer portion 500 of the third cannulasubassembly 176 in such a manner that the various vehicle support trackdefining members of the staging assembly are properly aligned with therespective inner facing tacks of the outer portion 500.

Preferably socket 1474 and corresponding flange 537 are formed to havesomewhat angled walls thereby to provide designed mutual mating thereof.A retaining pin 1476 engaging a socket 1478 in end mount 1452 and acorresponding socket 1480 in flange 537, may be provided to retain theflange 537 in mating engagement with socket 1474.

Preferably, the surgical vehicles and the various hands and tools aremounted onto a track defining member prior to attachment of the trackdefining member onto end mounts 1452. This can be seen, for example, inFIG. 30B, which shows a pair of track defining members 1466, eachslidably retaining a surgical vehicle 800 (FIGS. 25A & 25B) onto whichis mounted a hand 900 (FIG. 27) and a pick and place tool 1322 (FIG.29E).

FIG. 30C shows the pair of track defining members 1466 of FIG. 30B, eachslidably retaining a surgical vehicle 800 (FIGS. 25A & 25B) onto whichis mounted a hand 900 (FIG. 27) and a pick and place tool 1322 (FIG.29E), retained in seated engagement with the end mounts 1452 byretaining pins 1470. Additional track defining members 1464, 1466 and1468, which are not employed in the staging set-up of FIG. 30C, areshown in phantom in FIG. 31A.

Reference is now made to FIG. 31A and FIG. 31B which illustrate therelative arrangement and alignment of track defining members 1464, 1466and 1468 and the vehicles 800 riding thereon in the stage setup of FIG.30C. Track defining members 1464, 1466 and 1468, which are not employedin the staging set-up of FIG. 30C, are shown in phantom.

Reference is now made to FIG. 32A, which is a general pictorialillustration of an operating environment employing a preferredembodiment of the preset invention. The operating environment of FIG.32A may be located in a conventional operating theater, which isindicated generally by reference numeral 1500.

In accordance with a preferred embodiment of the invention, theoperator, who is typically a medical doctor trained to conductoperations in accordance with the present invention, is located at asite, indicated generally by reference numeral 1502, which is remotefrom the location of the patient in the operating theater on supporttable 100 (FIG. 1).

If desired, a partition 1504 may be placed, between the operator site1502 and the support table 100 so as to reduce distractions to theoperator from the activities taking place in the operating theateradjacent the patient on table 100.

Normally an array of equipment to be used in carrying out the operationin accordance with a preferred embodiment of the invention will beprovided on a support 1506 located in the vicinity of table 100. Theequipment, indicated generally by reference numeral 1507, may include,inter alia, hands, such as that shown in FIG. 27, and cannulae such asthose shown in FIG. 9.

A staging complex 1508, a preferred embodiment of which is describedhereinbelow with reference to FIG. 32C, preferably comprising aplurality of staging assemblies 1450 (FIGS. 30A-30C), a preferredembodiment of which is described hereinabove with reference to FIGS.30A-30C and 31, is operated preferably by a staging technician formodularly connecting various pieces of equipment together and mountingthem onto surgical vehicles for use in each stage of the operation, asappropriate.

Thus, it may be appreciated that in accordance with a preferredembodiment of the present invention, although the usual operating roompersonnel are present in the vicinity of the patient, the operator maybe remote therefrom and carry out the op on through the use of imagingapparatus such as virtual reality apparatus.

In accordance with a preferred embodiment of the present inventioncommunications equipment including video monitors 1510 and intercoms1512 may be located in the vicinity of support table 100 andcorresponding monitors 1520 and intercoms 1522 may be located at theoperator site 1502.

Reference is now made additionally to FIG. 32B, which is a gal pictorialillustration of an operator interface forming part of the operatingenvironment of FIG. 32A.

The operator interface, which is indicated generally by referencenumeral 182 (FIG. 5), typically comprises an operator support seatassembly, indicated generally by reference numeral 1550. Operatorsupport seat assembly 1550 typically comprises a fixed base 1552 andselectably vertically raisable and lowerable leg portions 1554. Fixedlyattached to leg portions 1554 is a back and head support 1556, a seat1558, which is swivelable in a generally horizontal plane about avertical axis 1560, and adjustably fixable arm supports 1662.

A plurality of foot control pedals, indicated generally by referencenumeral 1666, are preferably arranged in an arc about vertical axis 1560so as to be readily engageable by an operator seated on seat 1558 whoswivels the seat appropriately. Foot control pedals 1666, preferablyinclude clockwise and counterclockwise visualization rotation controlpedals 1668 and 1670 respectively, a relatively raised visualizationzoom control pedal 1672 and forward and rearward drive pedals 1674 and1676 respectively as well as a brake pedal 1678.

Pedals 1674, 1676 and 1678 may be employed to govern translation offirst, second and third cannula subassemblies 172, 174 and 176 (FIG. 9)and surgical vehicles, such as vehicles 700, 750 and 800 (FIGS. 23A,23B, 24A & 24B and 25A & 25B respectively). Additionally foot controlpedals 1666 may include one or more function select pedals 1680.

The operator interface typically comprises display 1520, which maycorrespond to display 146 (FIG. 2) and which may be coupled to computer148 or to a terminal thereof (FIG. 2). It is appreciated that thecomputer 148 may be located remotely from the operator interface and maybe appropriately networked therewith and with other computer systems asappropriate. Computer input devices, such as a keyboard 1694, a mouse1695 and one or more joystick 1696 may be provided for use by theoperator.

Additionally or alternatively, the operator may be provided with avirtual reality set 1698 which interfaces with computer 148 and virtualreality gloves or other hand interfaces 1700. Headset 1698, gloves andother hand ices 1700 may be entirely conventional.

Preferably, the virtual reality headset 1698 displays in a generallyhorizontal plane, a three-dimensional enlarged image of the end plate ofa vertebra which is being operated on in accordance with a preferredembodiment of the present invention.

In accordance with a preferred embodiment of the present invention,operator-viewable virtual reality headset 1698 provides to the operatora sense that his bands are located within a region between adjacentvertebra at which the operation is taking place and are able toaccurately manipulate various hands, such as that shown in FIG. 27within that region, using the virtual reality gloves or other handinterfaces 1700 and taking full advantage of the enlargedthree-dimensional image provided by headset 1698.

It is a particular feature of the present invention that the plane inwhich the patient's spine is viewed by the operator using virtualreality headset 1698 need have no relationship with the actualorientation of the patients spine as he is supported on table 100.Typically, the patient will be lying down, but the operator will viewhis spine oriented in a fixed position as if he were standing up.

Reference is now made to FIG. 32C, which illustrates the staging complex1508 of FIG. 32A. As seen in FIG. 32C, the staging complex 1508typically comprises a base 1702 on which a plurality of stagingassemblies 1450 may be placed at various stages of assembly of tools andhands to surgical vehicles. As seen in FIG. 32C, this assembly istypically carried out manually by one or more staging technicians whomay be prompted, preferably by a multi-media prompt which may employvideo displays 1520 (FIG. 32A). Preferably, the required arrangement oftools and hands for every stage of the operation is visually indicatedto the technician on a display 1510.

Staging assemblies 1450 are provided in order to ensure proper alignmentof the surgical vehicles and the tools and hands connected thereto uponinsertion thereof into the third cannula subassembly 176. This alignmentis of particular importance considering the very small clearancesbetween various surgical vehicles and their respective tools and handswhich may be simultaneously located within the cannula subassembly.

FIG. 32C also illustrates that the technician may assemble the requiredtool and hand onto a required surgical vehicle using a staging assembly1450 in an off-line relationship with the third cannula subassembly.When an assembled surgical vehicle, tool and hand is ready for insertionon a staging assembly 1450, the staging assembly may be seated by thetechnician onto flange 537 of the outer portion 500 of the third cannulasubassembly 176 (FIG. 16).

Once the staging assembly 1450 is seated onto flange 537, the assembly,surgical vehicle, tool and hand may be slid from backs in the stageassembly onto corresponding tracks 504, 506 and 508 formed on theinterior of outer portion 500, as appropriate.

In this way, multiple staging assemblies 1450 may be assembledsimultaneously by one or more technicians to enable the assembledequipment to be inserted in the third cannula subassembly as and whenrequired, so as to avoid delays in the operation, which might otherwiseoccur due to the need to assemble required equipment prior to insertionthereof into the third cannula subassembly.

Reference is now made to FIG. 32D, which is a composite virtual image ofthe possible relative positioning of the operator vis-a-vis arepresentation of a portion of the spine of a patient, which as seen bythe operator using his virtual reality headset 1698 is fixed in space.

FIG. 32D illustrates the possibility of the operator to change hisposition relative to the representation of a portion of the spine of apatient, which as seen by the operator using his virtual reality headset1698 is fixed in space. It is seen that the operator can “positionhimself” at any desired location relative to the representation of aportion of the spine of a patient by operating clockwise andcounterclockwise visualization rotation control pedals 1668 and 1670(FIG. 32B). Eight positions, numbered I, II, IV, V, VI VII, VIII areindicated.

In order to provide an understanding of what the operator sees using thesystem of the present invention, reference is made to FIGS. 33A, 33B and33C, which illustrate the spinal region of a patient as vitally viewedby the operator in positions II, III and IV respectively, as shown inFIG. 32D. It is to be appreciated that the virtual reality headset 1698and its associated software preferably adjust the view to take intoaccount the head orientation of the operator.

Reference is now made to FIG. 34, which is a general block diagram ofthe operator interface 182 (FIG. 5) which forms part of the operatingenvironment of FIGS. 32A-33C. As seen in FIG. 34, the operator interfacecomprises an operator visualization subsystem 1750 and anoperator-controlled driving subsystem 1760. The operator-controlleddriving subsystem 1760 and the operator visualization subsystem 1750together control all actions, other than purely manual actions, whichtake place.

The division of functions between the two subsystems may be taken to beessentially arbitrary, wherein the visualization subsystem 1750 dealswith providing information to the operator, while theoperator-controlled driving subsystem deal with all other activities,such as carrying out operator instructions in the course of theoperation, other than those directly related to providing information tothe operator.

The operator visualization subsystem 1750 receives inputs from computer148 (FIG. 2); real time imaging assembly 207 (FIGS. 6A & 6B); opticalsensors 315 (FIGS. 10A & 10B), 408 (FIG. 13), 532 & 562 (FIG. 16);pedals 1666, 1668, 1670 & 1680 (FIG. 32B); keyboard 1694 (FIG. 32B);mouse 1695 (FIG. 32B), joysticks 1696 (FIG. 32B) and hand interface 1700(FIG. 323).

The operator visualization subsystem 1750 prods outputs to illuminators316 (FIGS. 10A & 10B), 410 (FIG. 13) and 564 (FIG. 16); monitors 1510 &1520 (FIGS. 32A & 32B) and headset 1698 (FIG. 32B).

The operator-controlled driving subsystem 1760 interactively interfaceswith subsystem 1750 and also receives inputs from computer 148 (FIG. 2);pedals 1666 (FIG. 32B); keyboard 1694 (FIG. 32B); mouse 1695 (FIG. 32B);joysticks 1696 (FIG. 32B); hand interface 1700 (FIG. 32B); audio inputsfrom headset 1698 (FIG. 32B) and hand and tool identification andorientation inputs from multi-functional controller 253 (FIG. 7).

The operator-controlled driving subsystem 1760 provides outputs tocontroller 180, including hydraulic controllers 252 (FIG. 7), 371 (FIGS.12A-12C) & 607 (FIG. 19); multi-functional controller 253 (FIG. 7);linear driving controllers 266, 278 and 282 (FIGS. 8A-8C) & 579 (FIG.19) and rotational driving controllers 272 (FIG. 8A-8C), 367 (FIG. 12A)& 582 (FIG. 19).

The operation of operator visualization subsystem 1750 andoperator-controlled driving subsystem 1760 will now be described withreference to the flowcharts of FIGS. 35-47 and also with respect toFIGS. 48-163G which illustrate operation of a preferred embodiment ofthe invention.

Referring initially to FIG. 35, it is seen that the operation is plannedoff-line using medical data stored in computer 148 (FIG. 2) as well asimaging data derived from earlier patient imaging as describedhereinabove and shown in FIG. 2. The option planning is carried out byan operator, preferably a surgeon, and may be carried out at anysuitably equipped location at any suitable time using the resources ofcomputer 148 via any sale network (Step A in FIG. 35).

In planning the operation, the surgeon relies on known reference medicaldata including known medical imaging information which is currentlyavailable on computer networks. As indicated in Steps A & B shown FIG.36A, the surgeon preferably downloads stored medical data regarding thepatient to be operated upon from computer 148 as well as reference dataregarding the operation to be performed and the relevant anatomy.

Having familiarized himself with the aforesaid reference data and themedical data relevant to the particular patient, the surgeon determinesthe desired patient orientation for pre-operative imaging and performscomputer simulated imaging based on the desired patient orientationindicated by him.

It is a preferred feature of embodiments of the invention that not onlyat the various planning stages but also in the course of the operation,the surgeon is provided with state of the art interactive visualizationand control interface devices, preferably including virtual realityheadset 1698 (FIG. 32B), such as a CyberEye Head-Mounted Display,commercially available from the General Reality Company of Half MoonBay, Calif., USA, preferably including both stereo video and stereoaudio output functionalities as well as audio input functionalities.Additional visualization and control interface devices available for useby the surgeon are described hereinabove with reference to FIG. 32B.

Preferably, the visualization interface devices available to the surgeonhave both rotation and zoom functionalities.

Using the aforesaid visualization interface devices, the surgeonanalyzes the computer simulated imaging and modifies or confirms thefinal desired patient orientation for pre-operative imaging (Steps C, D,E & F in FIG. 36A). At this stage, the patient presents himself forpre-operative imaging and is fixed onto support table 100 (FIG. 1) whichis oriented in accordance with the final desired patient orientationdetermined by the surgeon or other able operator.

Support table 100 is preferably oriented by downloading data indicatingthe earlier determined final desired patient orientation from computer148. This data indicates, inter alia, the required repositioning ofchest support portion 102 relative to lower body support portion 115 bymeans of motors 113. Repositioning instructions are supplied by theoperator controlled driving subsystem 1760 to controller 114 whichgoverns the operation of motors 113 and preferably confirms correctoperation thereof and correct relative positioning of tale portions 102and 115.

Patient imaging is then performed utilizing the apparatus of FIG. 2.(Steps G & H in FIG. 36A) It is appreciated that any suitable type orcombination of types of patient imaging may be employed. Currenttechniques of patient imaging include ML ultrasound, CAT scanning, X-rayand provide selectably downloadable three-dimensional patient imagedata.

The patient imaging outputs are preferably stored in computer 148 andare compiled in a manner to make readily available to the operator, ouchas the surgeon, images which are required to plan the operation.Commercially available software, such as IDXRAD, commercially availablefrom IDX Systems Corporation, Burlington Vt., U.S.A., may be used forimage compilation and accessing. Preferably, computer 148 also operatesas a server in a server-client environment over a conventional computernetwork.

It is thus appreciated that pre-operative patient imaging need not takeplace at the same location at which the operation take place.

Preferably, but not necessarily, while the patient remains available forpatient imaging, an operator views patient imaging data stored oncomputer 148 for the region of interest by utilizing conventionalclient-server image compilation and transmission techniques. Theoperator preferably operates an operator interface incorporatingvisualization subsystem 1750 and analyzes the imaging informationrelating to the region of interest.

If and as necessary, the imaging data derived from patient imaging asaforesaid may be supplemented, particularly in the region of interestwith medical reference data stored in computer 148. Composite images maybe provided to the operator, preferably characterized in that patientimaging data is clearly distinguished from overlaid reference data.

The operator then analyzes the thus supplemented patient image data. Ifand as necessary, additional patient imaging procedures are carried outuntil the desired completeness and acceptability of the stored patientimage data is confirmed by the operator. Upon confirmation of the storedpatient image data, a patient image data coordinate system, hereinafterreferred to as coordinate system I, is associated with all patient imagedata (Steps I, J, K, L, M, N, O in FIG. 36A).

At this stage, the surgeon is ready to plan the operation. In planningthe operation, the surgeon preferably has at his disposal the interfaceapparatus described above with reference to FIG. 32B, including, interalia, one or more of pedals 1666, 1668, 1670, monitor 1520, keyboard1694, joysticks 1696, mouse 1695, headset 1698 and hand interface 1700(Step A in FIG. 36B).

In planning the operation, the surgeon determines the type and size of aspinal device to be implanted or other surgical procedure, such asrestoration of vertebra, to be carried out. In this context, the surgeondetermines the general methodology to be employed and the selection ofsurgical vehicles, hands and tools which are most appropriate for thesurgery to be carried out. It is appreciated that during the course ofplanning and carrying out the surgery, the selection of devices surgicalvehicles, hands and tools may be modified (Step A1 in FIG. 36B).

The surgeon preferably determines the navigation path of the firstcannula subassembly 172 (FIGS. 9, 10A & 10B) in three spatial dimensionsand over time. Reference is made in this connection to FIG. 48 whichillustrates a portion of the intended navigation path of the firstcannula subassembly, designated by reference numeral 2002, in theenvironment of a dysfunctional spinal disc 2003 and adjacent respectiveupper and lower vertebrae 2004 and 2005 (Step A2 in FIG. 36B).

The surgeon preferably initially determines an intended anchoringlocation 2010 preferably on disc 2003. The surgeon then determines theintended navigation path 2002 from an entry location 2012 to theintended anchoring location 2010 in disc 2003. Having determined theintended path 2002, the surgeon knows the optimal position and angle oforientation of the first cannula subassembly 172 for entry at the entrylocation 2012 and navigation along path 2002.

Having established the optimal position and angle of orientation of thefirst cannula subassembly 172 in coordinate system I, the operatorpreferably centers coordinate system I at the intended anchoringlocation 2010 and thereafter brings coordinate system I into precise,identically scaled and locked three-dimensional alignment with acoordinate system of the cannula mounting assembly 204 (FIG. 6A),hereinafter referred to as coordinate system II.

From this point onward in planning the operation, coordinate systems Iand II are determined to be locked together and identical for allpurposes. Overlaying, scaling and locking of the two coordinate systemsI and II are computer functions that are carried out by operatorvisualization subsystem 1750 (FIG. 34) utilizing conventionaltechniques.

The surgeon then plans the anchoring of the first cannula subassembly172 at anchoring location 2010 and thereafter determines the timing ofinsertion of the second cannula subassembly 174 over the first cannulasubassembly 172 (Step A3 in FIG. 36B).

The surgeon completes the planning of the insertion of the secondcannula subassembly 174, which serves essentially as a spacer, guide andsupport for the third cannula subassembly 176. It is appreciated thatthe second cannula subassembly 174 may comprise one or more intermediatecannulae serving as spacers, guides and supports.

Thereafter, the surgeon determines the position and timing of theinsertion of the third cannula subassembly 176 over the first and secondcannula subassemblies 172 and 174 respectively. It is appreciated thatinsertion of the third cannula subassembly permits limited changes to bemade to the navigation path 2002, as is described hereinbelow.

The surgeon then plans anchoring of the third cannula subassembly ontovertebra 2005 at an intended anchoring location 2014 thereon (Step A4 inFIG. 36B).

Having established the intended anchoring loin of the third cannulasubassembly 176 in locked coordinate systems I & II the operatorpreferably centers coordinate systems I & II at the intended anchoringlocation 2014 and thereafter bring coordinate systems I & II intoprecise, identically scaled and locked three-dimensional alignment witha coordinate system centered at intended anchoring location 2014 invertebra 2005, hereinafter referred to as coordinate system III.

From this point onward in planning the operation, coordinate systems I,II and III are determined to be locked together and identical for allpurposes. Overlaying, scaling and locking of the three coordinatesystems I, II and III are computer functions that are carried out byoperator visualization subsystem 1750 utilizing conventional techniques.

In planning the anchoring of the third cannula subassembly onto vertebra2005 at intended anchoring location 2014, the surgeon selects at leasttwo screw engagement locations 2016 on vertebra 2005 for engagement byscrews 520 (FIG. 16). At this stage, the surgeon preferably finalizeshis selection of the configuration of the third cannula insofar as itrelates to the precise engagement of the third cannula with vertebra2005.

The surgeon may now determine the timing of removal from the body of thepatient of the first cannula subassembly 172, the second cannulasubassembly 174 and the inner portion 502 of the third cannulasubassembly 176 (Step A5 in FIG. 36B).

Following planning of the removal of the first cannula subassembly 172,the second cannula subassembly 174 and the inner portion 502 of thethird cannula subassembly 176 from the patient, the surgeon determinesthe timing and technique to be used for suctioning disc 2003 (FIG. 48)(Step A6 in FIG. 36B). The surgeon may use conventional techniques andapparatus for this purpose, such as techniques and apparatus employed inlumbar fusion.

Examples of such techniques and apparatus include those described inCurrent and Future Approaches to Lumbar Disc Surgery (A LiteratureReview) By C. H. Alleyne Jr. and G. E. Rodts Jr. Medscape Orthopedics &Sports Medicine which appears on the Internet onhttp:/www.medscape.com/Medscape/OrthoSportsMed/1997/v01.n11;mos3518/07/98mos3, as well as in the references cited therein, thedisclosure of all of which is hereby incorporated by reference.

Following completion of planning of disc suctioning, the surgeondetermines the timing and protocol for any required restoration of endplates 2024 and 2025 of vertebrae 2004 and 2005 respectively (Steps A7and A8 in FIG. 36B).

Restoration of end plates 2024 and 2025 preferably employs milling tool1300 (FIG. 29A), which is preferably employed in association withsurgical vehicle 700 (FIGS. 23A & 23B) and universal hand 900 (FIG. 27).

Reference is now made in this connection to FIGS. 49A, 49B, 49C, 49D and49E which illustrate various stages in reconstructing a vertebra endplate in accordance with one preferred embodiment of the presentinvention. FIG. 49A is a partially cut-away illustration of the topsurface 2135 of a typical end plate, such as end plate 2025, prior toreconstruction. It is seen that the end plate has been worn down and isrelatively thin and thus weak at certain locations, such as thoseindicated by reference numeral 2137.

FIG. 49B illustrates the top surface 2135 of end plate 2025 as it shouldappear following planned completion of an initial milling stage defininga recess 2145 for one type of implant, comprising a generally “beanshaped” inflatable pillow, such as that described hereinbelow withreference to FIGS. 53B & 53C, as well as a network of channels 2147,typically including a plurality of generally radially directed channels2148 and a peripheral channel 2175. In the course of the planned initialmilling stage, the top surface 2135 of end plate 2025 is to be milled toprovide a generally smooth milled surface 2165 having recess 2145 formedgenerally at the center thereof.

In accordance with one embodiment of the invention, a central region2155 (FIG. 49A) of each of the end plates is milled initially to enableinsertion of an inflatable implant thereat and thereafter, followinginflation of the inflatable implant, the remainder of the end plate ismilled. Alternatively, the machining of the end plates can take placegenerally prior to insertion of the inflatable implant. The lattertechnique is described herein.

FIG. 49C illustrates the top surface 2135 of end plate 2025 as it shouldappear following planned completion of a reinforcement placing stage inthe course of which a reinforcement fabric 2167, such as a fabric wovenof fibers made from high performance materials, such as DYNEMMA®,KEVLAR® and carbon, are placed in channels 2147.

FIG. 49E illustrates the insertion of a top surface plate 2168,typically formed of titanium or cobalt-chrome steel following suitablemachining of the top surface 2135 of end plate 2025 (FIG. 49D). Thetechnique illustrated in FIGS. 49D and 49E is an alternative to thetechnique illustrated in FIGS. 49B and 49C. It is appreciated that thesize limitations associated with the outer portion 500 of the thirdcannula subassembly 176 normally limit the maximum width of top surfaceplate 2168 or may require that it be formed of several separate portionswhich may be joined in situ.

It is appreciated that the planned reconstruction of end plate 2024 ispreferably substantially identical to, substantially symmetrical withand substantially spatially matched to the above-described plannedreconstruction of and plate 2025 as described hereinabove with referenceto FIGS. 49A-49F.

It is to be appreciated that the planed reconstruction steps deshereinabove with reference to FIGS. 49A-49E employ the stored peat imagedata and are, of necessity, lined to the intended configuration of theimplant and its operating environment.

Reference is now made to FIGS. 50A, 50B and 50C which illustrate variousstages in reconstructing a vertebra end plate in accordance with anotherpreferred embodiment of the present invention. It is appreciated thatunder sable dram, elements of the reconstruction described hereinabovewith reference to FIGS. 49A-49E may be combined with elements of thereconstruction described hereinbelow with reference to FIGS. 50A-50C.

FIG. 50A is a pictorial illustration of the top surface 2235 of atypical end plate, such as end plate 2025, prior to reconstruction. Itis seen that a portion 2237 of the end plate has buckled.

FIG. 50B illustrates the top surface 2235 of end plate 2025 as it shouldappear following planned completion of an initial milling stage toprovide a recess 2238 encompassing budded portion 2237, for receiving abone graft.

As seen in FIG. 50C, a bone a 2239 is to be inserted in recess 2238, itbeing appreciated that the bone graft 2239 is to be prepared off-linewith precise dimensions corresponding to those of recess 2238 and suchthat a portion 2240 of the bone graft protrudes slightly from topsurface 2235. The bone graft may be secured in place in recess 2238 byany suitable technique.

It is appreciated that following completion of the bone graft, any ofthe procedures described hereinabove with reference to FIGS. 49B-49E maybe carried out.

It is appreciated that the planned reconstruction of end plate 2024 ispreferably substantially identical to, substantially symmetrical withand substantially spatially matched to the above-described plannedreconstruction of end plate 2025 described hereinabove with respect toFIGS. 50A-50C.

It is to be appreciated that the planned reconstruction steps describedhereinabove with reference to FIGS. 50A-50C employ the stored patientimage data and are, of necessity, linked to the intended configurationof the implant and its operating environment.

Reference is now made to FIGS. 51A, 51B and 51C which illustrate variousstages in reconstructing a vertebra end plate in accordance with yetanother preferred embodiment of the present invention for the purpose oftreating scoliosis. It is appreciated that under suitable circumstances,elements of the reconstruction described hereinabove with reference toFIGS. 49A-49E and 50A-50C may be combined with elements of thereconstruction described hereinbelow with reference to FIGS. 51A-51C.

FIG. 51A is a pictorial illustration of the top surface 2330 of atypical end plate 2332 of a patient suffering from scoliosis, prior toreconstruction. It is seen that the end plate 2332 is slanted inasmuchas the entire vertebra has degenerated from its original configuration,shown in phantom lines at reference numeral 2334.

FIG. 51B illustrates the top surface 2330 of end plate 2332 as it shouldappear following planned completion of an initial milling stage toprovide a seat 2337 and a channel 2338 for securely receiving a bonegraft.

As seen in FIG. 51C, a bone graft 2339 in the form of a wedge is to beattached at seat 2337 and secured in channel 2338, it being appreciatedthat the bone graft 2339 is to be prepared off-line with precisedimensions corresponding to those of sea 2337 and channel 2338 and suchthat a portion 2340 of the bone graft protrudes from top surface 2330 asshown in FIG. 51C. The bone graft may be secured in place on seat 2337by any suitable technique.

It is appreciated that following completion of the bone gA any of theprocedures described hereinabove with reference to FIGS. 49B-49E may becarried out.

It is also appreciated that the planned reconstruction of an end platefacing end plate 2332 for scoliosis treatment may be substantiallyidentical to, substantially symmetrical with and substantially spatiallymatched to the above-described planned reconstruction of end plate 2332described hereinabove with respect to FIGS. 51A-51C. Alternatively, onlyone end plate in a pair of facing vertebra may be so treated, dependingon the extent of the disease.

It is to be appreciated that the planned reconstruction steps descriedhereinabove with reference to FIGS. 51A-51C employ the stored patientimage data and are, of necessity, linked to the intended configurationof the implant and its operating environment.

Following completion of planning of end plate reconstruction, thesurgeon determines the timing and protocol for machining end plates 2024and 2025 (Step 7 in FIG. 36B) of respective adjacent vertebra 2004 and2005 (FIG. 48). Machining end plates 2024 and 2025 preferably employsmilling tool 1300 (FIG. 29A), which is preferably employed inassociation with surgical vehicle 700 (FIGS. 23A & 23B) and universalhand 900.

It is appreciated that treatment of scoliosis in accordance with thepresent invention may be effected by suitable reconstruction of thevertebra, by insertion of a suitable configured disc replacementimplant, or by a combination of both of the foregoing. For this purposedisc replacement implants of various types described herein, preferablyhaving an overall wedge shaped configuration, may be employed.

Reference is now made in this connection to FIGS. 52A, 52B and 52C whichillustrate various stages in machining a vertebra end plate inaccordance with a preferred embodiment of the present invention.

FIG. 52A illustrates a top surface 2400 of a typical end plate, such asend plate 2025, prior to machining. FIG. 52B illustrates the top surface2400 of end plate 2025 as it should appear following planned completionof an initial milling stage defining a recess 2402 for one type ofimplant, comprising a generally “bean shaped” inflatable pillow, such asthat described hereinbelow with reference to FIGS. 53B & 53C.

In the course of the planned initial milling stage, a generally centralregion 2404 of the top surface 2400 of end plate 2025 is to be milled toprovide a generally smooth milled surface 2406 having recess 2402 formedgenerally at the center thereof.

FIG. 52C illustrates the top surface 2400 of end plate 2025 as it shouldappear following planned completion of a second milling stage in thecourse of which a peripheral channel 2408 is to be formed surroundingrecess 2402.

It is appreciated that the planned machining of end plate 2024 ispreferably substantially identical, substantially symmetrical with andsubstantially spatially matched to the above-described planned machiningof end plate 2025.

It is to by appreciated that the planned machining steps describedhereinabove with reference to FIGS. 52A-52C employ the stored patientimage data and are, of necessity, linked to the intended configurationof the implant and its operating environment.

Following completion of planning of the above-described steps ofmachining end plates 2024 and 2025 of respective adjacent vertebra 2004and 2005 (FIG. 48), the surgeon determines the timing and protocol forinsertion of the intended implant between end plates 2024 and 2025 ofrespective adjacent vertebra 2004 and 2005 (FIG. 48).

Insertion of the implant between end plates 2024 and 2025 preferablyemploys at least a pair of pick and place tools 1322 or 1324 (FIG. 29E),and an inflation tool 1350 (FIG. 29F), each of which is may be employedin association with surgical vehicle 700 (FIGS. 23A & 23B) but may beadvantageously employed on one or more surgical vehicles 750, 800 and850 (Step A9 in FIG. 36B).

It is appreciated that when surgical vehicles 750, 800 and 850, each ofwhich moves along a single track 504, are used, there ousts thepossibility that up to four tools may be employed simultaneously withoutmutual interference, thereby to provide the functionality of up to fourfingers in inserting the implant.

Reference is now made in this connection to FIGS. 53A, 53B and 53C whichillustrate various intended stages in insuring an implant between endplates 2024 and 2025 in accordance with a preferred embodiment of thepresent invention. FIG. 53A illustrate the prepared top surface 2420 ofa typical end plate 2425, such as end plate 2025, following machining asshown in FIG. 52C. Top surface 2420 is preferably formed with a recess2445 and a channel 2475 for accommodating an intended implant. Recess2445 correspond to recess 2402 in FIG. 52C. Channel 2475 corresponds tochannel 2408 in FIG. 52C.

FIG. 53B illustrates a typically “bean shaped” inflatable implant 2480located in recess 2445 on top surface 2420 of end plate 2425 as itshould appear following insertion thereof between adjacent fining endplates. Inflatable implant 2480 is intended to have multiple functions,including an initial function to force the facing end plates apart, soas to create a work volume therebetween to enable further insertion ofadditional implants therebetween. Thereafter and most importantly, theinflatable implant 2480, upon being somewhat deflated, is operative, incooperation with the additional implants, to permanently maintain thefacing end plates in a desired mutual orientation, while providingdesired shock absorbing therebetween.

In accordance with a preferred embodiment of the present invention, adisc replacement coil implant is provided generally surrounding theinflatable implant. Two principal types of disc replacement coils aredescribed hereinbelow, a generally flat coil, termed a “flat discreplacement coil” and a generally upstanding coil, termed an “upstandingdisc replacement coil”. It is appreciated that other types of discreplacement implants may also be employed in accordance with the potinvention.

FIG. 53C illustrates a portion of a flat disc replacement coil implant2490 in place surrounding implant 2480, as it should appear followingplanned completion of the implant insertion stage. It is noted thatimplant 2490 includes a protrusion 2492 which seats in channel 2475(FIGS. 53A-53C).

It is to be appreciated that the planned implant insertion stepsdescribed hereinabove with reference to FIGS. 53A-53C employ the storedpatient image data and are, of necessity, linked to the intendedconfiguration of the implant and its operating environment.

Following completion of planning of implant insertion, the surgeonpreferably determines the timing and protocol for disengagement of thethird cannula subassembly 176, various surgical vehicles, hands 900 andvarious tools from the surgical site adjacent the spine (Step A10 inFIG. 36B). Normally, this disengagement is carried out, by disengagingthe previously anchored outer portion 500 of the third cannulasubassembly 176 from the vertebra 2005 and thereafter, by removing thethird cannula subassembly 176, including the surgical vehicles, handsand tools, in a number of stages, at each of which the outer portion 500of the third cannula subassembly 176 is retracted and tissue suturingtakes place.

The operation plan is now complete and is stored in memory (Step A11 inFIG. 36B).

Returning now to FIG. 35, following planning of the operation, asimulated operation is preferably carried out on a computer in anoff-line manner (Step B). The off-line simulation preferably employs thestored patient image data and is, of necessity, linked to the intendedconfiguration of the implant and its operating environment.

In accordance with a preferred embodiment of the present invention, thesurgeon experiences the simulated operation using all of the suitablehuman interface resources provided by and associated with the operatorvisualization subsystem 1750 (FIG. 34). During or following presentationof the simulation, based on the surgeon's own analyses and/or computeranalyses of the simulated option, the surgeon may modify any appropriateaspect of the planned operation. Following such modifications, themodified planned operation is stored in memory and again simulated forthe surgeon until the surgeon is satisfied with the simulated resultsthereof (Step C in FIG. 35).

The steps of carrying out the simulated operation are summarized in theflowchart of FIG. 37 and typically include interactively selecting themode and timing of display as well as angles of view and magnification(Steps A, B & C in FIG. 37). Automatic analysis and danger warningsystems are preferably operated utilizing stored medical data includingboth data specific to the patient and non-patient specific anatomicaldata (Step D in FIG. 37).

The surgeon normally selects a desired type or types of simulated realtime vision and is able to interactively intervene in the simulation tochange the planned operation in the course of the simulation (Steps D, E& F in FIG. 37). The surgeon may also train himself by interactivelysimulating low probability situations which may occur in the course ofthe operation (Step G in FIG. 37) and may store modified simulatedoption procedures and data in memory (Step H in FIG. 37).

The analysis and modification steps are summarized in the flowchart ofFIG. 38 and typically include applying computerized analysis to thesimulated operation to provide optimalization and minimize risk (StepA). Preferably, comments and warnings from the computerized analysis aredisplayed in overlay to the surgeon in the course of his experiencingthe simulation (Step B in FIG. 38).

The surgeon preferably inputs his modifications in an interactive mannersuch that the modifications are also subject to computerized analysis(Step C in FIG. 38). This operator-modified simulated operation isrepeatedly presented to the surgeon with appropriate comments andwarnings from the computerized analysis until all desired modificationshave been entered and have been the subject of all suitable computerizedanalysis (Steps D, E & F in FIG. 38). At this stage, the surgeonconfirms the final operation plan, which is stored in memory (Step G inFIG. 38).

At this stage the operation may be finally scheduled and performed (StepD in FIG. 35) as will now be described with reference to FIGS. 39A-39D,which illustrate operation of the operator visualization subsystem 1750(FIG. 34) and FIGS. 40-47, which illustrate operation of theoperator-controlled driving subsystem 1760. In the course of thedescription which follows, reference is also made to FIG. 54A-163G whichare pictorial illustrations indicating various stages in the operationin accordance with a preferred embodiment of the present invention.

As indicated in FIGS. 39A & 39B, immediately prior to the operation,preferably on the same day as the operation, the surgeon obtains currentpatient medical data and downloads the final operation plan fromcomputer 148 (Steps A & B in FIG. 39A). The surgeon analyzes the finaloperation plan in view of the current patient medical data available tohim and interactively modifies or aborts the final operation plan inview of the current patient medical data (Steps C & D in FIG. 39A). Atthis stag the surgeon preferably makes a final decision to proceed withthe operation or to abort (Step E in FIG. 39A).

If the surgeon decides to proceed, the patient is positioned on supporttable 100 (FIG. 1) and the surgeon or an assistant operatesoperator-controlled driving subsystem 1760 to position the patient inaccordance with the previously determined final desired patientorientation for immediate pre-operation imaging (Steps F & G in FIG.39A).

Reference is specifically made in this connection to step A of theflowchart of FIG. 42 and to FIG. 43 which illustrates details of thisstep.

As indicated in FIG. 43, the final operation plan is downloaded fromcomputer 148 via operator visualization subassembly 1750 and therequired patient orientation is extracted from the final operation plan(Steps A & B). The required repositioning of chest support portion 102(FIG. 1) relative to lower body support portion 115 (FIG. 1) is carriedout by means of motors 113 and 118 and controllers 114 and 119 (FIG. 1)(Steps C & D in FIG. 43).

The patient is fixed to chest support portion 102 of support table 100by means of back brace assembly 120 employing bolts 122 (FIG. 1) (Step Hin FIG. 39A). Similarly, the pelvis of the patient is securely bracedonto the lower body support portion 115 by means of pelvic braceassembly 124 as by bolts 125 and the thighs of the patient are bracedonto lower body support portion 115 by means of thigh brace assemblies126, as by bolts 127 (FIG. 1).

It is appreciated that the desired positioning of lower body supportportion 115 relative to chest support portion 102 applies desiredtraction, if needed, to the patients spine, by transmittingrepositioning instructions to controllers 114 and 119.

Immediate pre-operation patient imaging is performed preferablyutilizing the apparatus of FIG. 2 (Step I in FIG. 39A). It isappreciated that any suitable type or combination of types of patientimaging may be employed. Current techniques of patient imaging includeMRI, ultrasound, CAT scanning and X-ray and provide selectablydownloadable three-dimensional patient image data.

The immediate pre-operation patient imaging outs are preferably store incomputer 148 and are compiled in a manner to make readily available tothe operator, such as the surgeon, images which are required to carryout the operation (Step J in FIG. 39A).

Preferably, but not necessarily, while the patient remains available forpatient imaging an operator views patient imaging data stored oncomputer 148 for the region of interest by utilizing conventionalclient-sever image compilation and transmission techniques. The operatorpreferably operates an operator interface incorporating visualizationsubsystem 1750 and analyzes the imaging information relating to theregion of interest (Step K in FIG. 39B).

If and as necessary, the patient may be repositioned (Step L in FIG.39B) and reimaged. If and as necessary, the imaging data derived frompatient imaging as aforesaid may be supplemented, particularly in theregion of interest, with medical reference data stored in computer 148or any other suitable computer networked therewith. Composite images maybe provided to the operator, preferably characterized in that patientimaging data is clearly distinguished from overlaid reference data (StepM in FIG. 39B).

The operator then analyzes the thus-supplemented patient image data(Step N in FIG. 39B). If and as necessary, additional patient imagingprocedures are carried out until the desired completeness andacceptability of the stored patient image data is confirmed by theoperator and the surgeon, if different from the operator (Step O in FIG.39B).

Upon confirmation of the stored patient image data (Step P in FIG. 39B),a patient image data coordinate system, hereinafter referred to ascoordinate system IV, is associated with all patient image data.

The previously final operation plan is then preferably modified by thesurgeon, if and as necessary to conform to the actual fixed immediatepre-operation orientation of the patient. The surgeon typically employsone or more of foot pedals 1666, 1668, 1670, 1680, monitor 1520,keyboard 1694, joysticks 1696, mouse 1695, heet 1698 and interface 1700,all shown in FIG. 32B (Step Q in FIG. 39B).

The surgeon may then confirm the final real time staring operation planand may either confirm operation go ahead or abort the operation (StepsR & S in FIG. 39B).

Reference is now made specifically to FIG. 39C and to FIGS. 44A and 44Bwhich illustrate steps B and C in the flowchart of FIG. 42, and to FIGS.54A and 54B which illustrate the steps being carried out in the physicalenvironment of the operation.

As indicated in FIG. 44A, the cannula entry position is extracted fromthe final real time starting operation plan (Step A). The requiredrepositioning of carriage assembly 194 and platform 200 is carried outby means of respective electric motors 199 and 201 in response tocontrol inputs from respective rotational driving controllers 205 and206 (FIG. 6A) (Steps B & C in FIG. 44A).

The cannula entry angle is extracted from the final real time startingoperation plan (Step D in FIG. 44A). The required repositioning ofcentral aperture 220 is carried out by operation of pistons 240 and 242in response to control inputs supplied thereto by controller 252 (FIG.7) (Steps E & F in FIG. 44A).

As seen in FIGS. 54A and 54B, the first cannula subassembly 172 isinserted in accordance with the final real time starting operation planas modified interactively in real time by the surgeon using inputs,inter alia, from one or more of sensors 315 associated with illuminators316.

Reference is now made specifically to FIG. 44B which illustrates theoperations carried out by the operator-controlled driving subsystem 1760during the insertion of the first cannula subassembly 172.

The surgeon initiates penetration of the first cannula subassembly 172into the patient typically by an audio input via headset 1698 and/or aninput from hand interface 1700 or keyboard 1694 (Step 1 in FIG. 44B).

Using the final real time starting operation plan as modifiedinteractively in real time by the surgeon, a desired sequence ofcoordinated movements of the first cannula subassembly 172 is carriedout (Step 1A in FIG. 44B). These coordinated movements may include oneor more of linear forward motion of the first cannula subassembly bymotor 264 (FIG. 8A), rotation of the first cannula subassembly 172 bymotor 270 (FIG. 8A) and curvature control of the first cannulasubassembly by steering subassembly 330 (FIG. 12A) (Step 1B in FIG.44B).

The movements are effected by provision of synchronized instructions tocontroller 266 (FIG. 8A) for operation of motor 264, to controller 272(FIG. 8A) for operation of motor 270 and to controller 371 (FIG. 12A)for pistons 368 of steering subassembly 330 (Step 1C in FIG. 44B).

It is appreciated that the surgeon may interactively modify theforegoing operations in real time using the various input devices shownin FIG. 32B. The surgeon may advantageously make use of real-timeimaging assembly 207 (FIG. 6B) (Step 2 in FIG. 44B).

Reference is now made additionally to FIG. 55 which illustrates thefirst cannula subassembly 172 in engagement with a disc 2003. Uponengagement of the first cannula subassembly 172 with the disc 2003, theprovision of synchronized instructions to controller 266 for motor 264,to controller 272 for motor 270 and to controller 371 for pistons 368 ofsteering subassembly 330 are terminated (Step 3 in FIG. 44B).

The surgeon, preferably relying on real-time imaging assembly 207 (F&6B) provides confirmation of his approval of the engagement location onthe disc 2003 as an acceptable anchoring location 2010. Thisconfirmation may be provided by an audio input via headset 1698 and/oran input from hand interface 1700 or keyboard 1694 (Step 4 in FIG. 44B).

Anchoring of the first cannula subassembly 172 into the disc 2003 at theapproved anchoring location 2010 is achieved by providing suitableinstructions to a controller 367 to operate drill driving motor 362(FIG. 12A) to rotate shift 293, thereby to rotate screw 294 (FIG. 9)into anchored engagement with the disc 2003 (Steps 5, 6 & 7 in FIG.44B).

Reference is now made specifically to step C of the flowchart of FIG.39C, to FIG. 45 which illustrates step D in the flowchart of FIG. 42,and to FIGS. 56 and 56B which illustrate the steps being carried out inthe physical environment of the operation. As seen in FIGS. 56A and 56B,the second cannula subassembly 174 is slid over the first cannulasubassembly 172.

This takes place after steering subassembly 330 is removed from thefirst cannula subassembly 172 by operating slidable biasing element 372(FIG. 12B) to as to assume its second longitudinal position whereby itdoes not force flexible toothed shafts 370 into engagement with recesses308, thereby permitting disengagement of the steering subassembly 330from the first cannula subassembly 172.

In inserting the second cannula subassembly 174, the surgeon mayadvantageously make use of real-time imaging assembly 207 (FIG. 6B) aswell as sensors 408 which cooperate with illuminator 410.

Referring specifically to FIG. 45, it is seen that insertion of thesecond cannula subassembly 174 involves the following steps:

The insertion of the second cannula subassembly 174 along the outside ofthe first cannula subassembly 172 may be initiated by the surgeon via anaudio input using headset 1698 and/or via an input from hand interface1700 or keyboard 1694 (Step 1).

A desired sequence of movements of the second cannula subassembly isderived from the final real time starting operation plan as modifiedinteractively in real time by the surgeon (Step 1A). Linear forwardmotion of the second cannula subassembly 174 is produced by motor 276 inresponse to inputs supplied thereto by controller 278 (FIG. 8B) (Steps1B & 1C). When the second cannula subassembly 174 reaches disc 2003,controller 278 us off motor 276 (Step 3).

At this stage, the second cannula subassembly 174 is locked intoengagement with the first cannula subassembly 172, preferably by meansof the mechanism described above with reference to FIGS. 15A and 15B.Operation of the mechanism of FIGS. 15A and 15B for coupling of thefirst and second cannula subassemblies 172 and 174 respectively ispreferably automatic, when the second cannula subassembly 174 issuitably longitudinally positioned with respect to the first cannulasubassembly. Decoupling, required at a later stage is normally providedby manual engagement with part of the mechanism of FIGS. 15A and 15B.

Reference is now made specifically to step D of the flowchart of FIG.39C, to FIGS. 46A and 46B which illustrate step E in the flowchart ofFIG. 42, and to FIGS. 57A & 57B, 58A & 58B, 59A & 59B, 60A & 60B and 61A& 61B which illustrate the steps being carried out in the physicalenvironment of the operation.

As seen in FIGS. 57A & 57B, the third cannula subassembly 176 is slidover the second cannula subassembly 174. Insertion of the third cannulasubassembly takes place in accordance with the final real time operationplan as modified inactively in real time by the surgeon, using thevarious input devices shown in FIG. 32B. The surgeon may advantageouslymake use of real-time imaging assembly 207 (FIG. 6B).

As indicated in FIG. 46A, the insertion of the third cannula subassembly176 along the outside of the second cannula subassembly 174 may beinitiated by the surgeon via an audio input using headset 1698 and/orvia an input from hand interface 1700 or keyboard 1694 (Step 1).

A desired sequence of movements of the third cannula subassembly isderived from the final real time starting operation plan as modifiedinteractively in real-time by the surgeon (Step 1A in FIG. 46A). Linearforward motion of the third cannula subassembly 176 is produced by motor281 in response to inputs supplied thereto by contoller 282 (FIG. 8C)(Steps 1B & 1C in FIG. 46A).

It is appreciated that the above instructions may be appropriatelyamended by the operator (Step 2 in FIG. 46A). When the intended targetof the third cannula subassembly 176 is reached, controller 282 turnsoff motor 281 and steering assembly 542 (Step 3 in FIG. 46A). It isappropriate that due to the relatively larger cross-sectional dimensionsof the third cannula subassembly 176, it may be necessary to cut throughbody tissue surrounding the second cannula subassembly. One or moreblades 2006 may be provided adjacent the forward edge 503 of the thirdcannula subassembly for this purpose.

In accordance with a preferred embodiment of the present invention,slight corrections may be made in the location of the third cannulasubassembly 176 and thus of the first and second cannula subassemblies172 and 174, notwithstanding prior positioning of the first and secondcannula subassemblies as described hereinabove. This location correctionis preferably achieved by modifying the curvature of the third cannulasubassembly through use of the steering subassembly 542 describedhereinabove with reference to FIG. 16. Steering subassembly 542 providescurvature control, and thus desired positioning of the third cannulasubassembly in response to control inputs from controller 543.

It is to be appreciated that the surgeon employs the steeringsubassembly 542 for fine positioning of the third cannula subassembly asneeded in view of the imaging information that he obtains in real timeto high accuracy from real-time imaging assembly 207 (FIG. 6B) as wellas sensors 562 which cooperate with illuminators 564. (FIG. 16).

Referring now specifically to FIG. 46B and FIGS. 59A and 59B, it is seenthat when the forward edge 503 of the inner portion 502 engages vertebra2005 (FIG. 48) the third cannula subassembly 176 (FIG. 5) is coupled tothe second cannula subassembly 174 (FIG. 5) by means of flexibleengagement member 569 (FIGS. 18A and 18B) (Step A in FIG. 46B).

Following locking of the inner portion 502 of the third cannulasubassembly 176 to the second cannula subassembly 174 by engagementmember 569, as shown in FIG. 18B, the outer portion 500 of the thirdcannula subassembly is decoupled from the inner portion 502 thereof asby manual retraction of locking pia 575 (FIG. 18B) (Step B in FIG. 46B).

Controller 282 (FIG. 8C) then operates motor 281 (FIG. 8C) to move theouter portion 500 forward relative to the inner portion 502 until theforward edge 501 of the outer portion 500 engages the vertebrate 2004and 2005 (Step C in FIG. 46B). This engagement is shown in FIGS. 60A and60B. Controller 282 then terminates operation of motor 281.

At this stage, a surgeon or other operator, typically using a wrench,such as an Allen wrench, rotatably drives sockets 526 (FIG. 16) inengagement heads 524 (FIG. 16) of anchoring screws 520, 294 causing theanchoring screws 520, 294 to threadably engage vertebra 2005, thusanchoring the outer portion 500 of the third cannula subassembly tovertebra 2005 (Step D in FIG. 46B). FIGS. 61A and 61B illustrates theouter portion 500 anchored to vertebra 2005.

It is appreciated that alternatively or additionally, additionalanchoring screws 520, 294, in elongate bores 510 (FIG. 22) may beemployed for anchoring the outer portion 500 to vertebra 2005.

Reference is now made specifically to step A of the flowchart of FIG.39D, to FIG. 46B, part of which illustrates step F in the flowchart ofFIG. 42, and to FIGS. 62A & 62B which illustrate the steps carried outin the physical environment of the operation as summarized in steps 1A,1B & 1C in FIG. 47. As seen in FIGS. 62A & 62B, the first and secondcannula subassemblies 172 and 174 and the timer portion 502 of the thirdcannula subassembly 176 have been withdrawn through the outer portion500 of the third cannula subassembly.

Reference is now made specifically to step B of the flowchart of FIG.39D, to FIG. 46B, part of which illustrates part of step G in theflowchart FIG. 42, and to FIGS. 63 and 64 which illustrates the stepsbeing carried out in the physical environment of the operation.

Disc suctioning is performed preferably as per the final real timestarting operation plan as modified interactively in real time by theoperator using inputs inter alia from one or more of sensors 532associated with illuminators 533. Disc suctioning is carried out inaccordance with suitable conventional disc suctioning procedures.

As seen in FIGS. 63 and 64, mounted onto a surgical vehicle 700 (FIGS.23A & 23B), is a hand 900 (FIG. 27) and a first disc removal tool, suchas cutting tool 1380 (FIG. 29H). FIG. 64 shows the operating environmentat the completion of disc suctioning.

Reference is now made specifically to step C of the flowchart of FIG.39D, to step A of the flowchart of FIG. 46C, and to FIGS. 65A-65F,66A-66C and 67A-67C, which illustrate the steps being carried out in thephysical environment of the operation. The vertebrate 2004 and 2005 arerestored preferably using surgical vehicle 800 (FIGS. 25A & 25B), hand900 (FIG. 27), tool 1300 (FIG. 29A) and milling head 1002 (FIG. 28A) asrequired according to the final real time starting operation plan asmodified interactively in real time by the operator using inputs interalia from one or more of sensors 532 associated with illumination 533(FIG. 20), as summarized in Steps A, B, C, D and E in the FIG. 39D.

The various operational steps for vertebrate machining and implantationare summarized in Steps B, C, D and E in FIG. 46C. Post operationanalysis (Step E in FIG. 35) and the follow-up protocol (Step F in FIG.35), are summarized in Steps A, B, D, E, F, G, H, I and J in FIG. 40 andSteps A, B, C, D, E and F in FIG. 41, respectively.

Reference is now made in this connection to FIGS. 65A, 65B, 65C, 65D and65E which illustrate various stages in reconstructing a vertebra endplate in accordance with one preferred embodiment of the presentinvention. FIG. 65A is a partially cut-away illustration of the topsurface 2135 of a typical end plate, such as end plate 2025, at theonset of reconstructions.

It is seen that the end plate which has been worn down and is relativelythin and thus weak at certain locations, such as those indicated byreference numeral 2137, is being machined, as by use of vehicle 700(FIGS. 23A & 23B), hand 900 (FIG. 27), tool 1301 (FIG. 29B) and millinghead 1032 (FIG. 28D).

FIG. 65B illustrates the top surface 2135 of end plate 2025 followingcompletion of an initial milling stage defining a recess 2145 for onetype of implant, comprising a generally “bean shaped” inflatable pillow,such as that described hereinbelow with reference to any FIGS. 73A-75B,as well as a network of channels 2147, typically including a pluralityof generally radially directed channels 2148 and a peripheral channel2175. In the course of this stage, a generally central region 2155 ofthe top surface 2135 of end plate 2025 is milled to provide generallysmooth milled surface 2165 having recess 2145 formed generally at thecenter thereof.

FIGS. 65C and 65D illustrate the use of surgical vehicle 800 (FIGS. 25A& 25B), hand 900 (FIG. 27) and a pair of forceps tools 1313 (FIG. 29C)to insert, position and spread out reinforcing fabric 2167 over surface2165 of the end plate 2025. Reinforcing fabric 2167 may be impregnatedwith an adhesive which is activated in situ. Additionally oralternatively, a fluid adhesive may be provided using dispenser tool1319 (FIG. 29D). The intended result of this activity is shown in FIG.49C.

FIGS. 65E and 65F illustrate machining of the top surface 2135 of endplate 2025 and subsequent insertion and placement of top surface plate2168. The machining typically employs tool 1300 and milling head 1002while the insertion and placement typically employ at least a pair offorceps tools 1313.

As noted hereinabove, the technique illustrated in FIGS. 65E and 65F isan alternative to the technique illustrated in FIGS. 65B-65D. It is seenthat due to the size limitations associated with the outer portion 500of the third cannula subassembly 176 which normally limit the maximumwidth of top surface 2168, several separate portions are separatelyinserted and joined in situ.

Top surface plate 2168 may be impregnated with an adhesive which isactivated in situ. Additionally or alternatively, a fluid adhesive maybe provided using dispenser tool 1319 (FIG. 29D). Additionally oralternatively, the plate 2168 may be attached to the vertebra by screwsor others fasteners (not shown).

It is appreciated that the planned reconstruction of end plate 2024 ispreferably substantially identical to, substantially with, andsubstantially spatially matched to the above-described plannedreconstruction of end plate 2025 as described hereinabove with referenceto FIGS. 65A-65F.

It is to be appreciated that the planned reconstruction steps describedhereinabove with reference to FIGS. 49A-50C generally employ the storedpatient image data and are preferably linked to the intendedconfiguration of the implant and its operating environment.

Reference is now made to FIGS. 66A, 66B and 66C which illustrate variousstages in reconstructing a vertebra end plate in accordance with anotherpreferred embodiment of the present invention. It is appreciated thatunder suitable circumstances, elements of the reconstruction describedhereinabove with reference to FIGS. 49A-49E and 65A-65F may be combinedwith elements of the reconstruction described hereinabove with referenceto FIGS. 50A-50C and hereinbelow.

FIG. 66A is a pictorial illustration of matching of buckled portion 2337of the top surface 2235 of a typical end plate, such as end plate 2025.This matching step typically employs surgical vehicle 700 (FIGS. 23A and23B), hand 900 (FIG. 27), tool 1301 (FIG. 29B) and milling head 1032(FIG. 28D) to produce a desired recess 2238.

FIG. 66B illustrates insertion and placement of a bone graft 2239 inrecess 2238 in the top surface 2235 of end plate 2025. This step ispreferably carried out using surgical vehicle 800 (FIGS. 25A & 25B),hand 900 (FIG. 27) one or more forceps tools 1313 (FIG. 29C) engagingprotrusion 2240 on the bone graft.

FIG. 66C illustrates machining of the bone graft 2239 once it has beensecured in place in recess 2238 by any suitable technique. Thismachining step typically employs surgical vehicle 700 (FIGS. 23A & 23B),hand 900 (FIG. 27), tool 1300 (FIG. 29A) and milling head 1032 (FIG.28D) to produce a desired recess 2238. This machining step preferablyalso employs surgical vehicle 800 (FIGS. 25A & 25B), hand 900 (FIG. 27)and forceps tool 1313 (FIG. 29C) to retain the bone graft 2239 in placeduring machining.

It is appreciated that following completion of the bone graft, any ofthe procedures described hereinabove with reference to FIGS. 49B-49E and65A-65F may be carried out.

It is appreciated that the planned reconstruction of end plate 2024 ispreferably substantially identical to, substantially symmetrical with ansubstantially spatially matched to the planned reconstruction of endplate 2025 described hereinabove with respect to FIGS. 50A-50C and FIGS.66A-66C.

It is to be appreciated that the planned on steps described hereinabovewith reference to FIGS. 50A-50C generally employ the stored patientimage data and are preferably linked to the intended configuration ofthe implant and its operating environment.

Reference is now made to FIGS. 67A, 67B, 67C and 67D which illustratevarious stages in reconstructing a vertebra end plate in accordance withanother preferred embodiment of the present invention for the purpose oftreating scoliosis. It is appreciated that under suitable circumstances,elements of the reconstruction described hereinabove with reference toFIGS. 49A-49E, 50A-50C and 51A-51C may be combined with elements of thereconstruction described hereinbelow with references to FIGS. 67A-67D.

FIG. 67A is a pictorial illustration of machining of the top surface2335 of end plate 2336 of a patient suffering from scoliosis, typicallyemploying surgical vehicle 700 (FIGS. 23A & 23B, hand 900 (FIG. 27),tool 1300 (FIG. 29A) and a milling head 1042 having an inverted conicaltip 1044 (FIG. 28E) to provide, inter alia, seat 2337 (FIG. 51B)including a mounting step 2650.

FIG. 67B illustrates further machining of the top surface 2335 of endplate 2336 to provide channel 2338 (FIG. 51B) for securely receiving abone graft. This further machining typically employs surgical vehicle700 (FIGS. 23A & 23B), hand 900 (FIG. 27), tool 1300 (FIG. 29A) andmilling head 1002 having a rounded tip (FIG. 28A).

As seen in FIG. 67C, a bone graft 2339 (FIG. 51C) in the form of a wedgeis attached at seat 2337 and secured in channel 2338 (FIG. 67B).Preferably by using surgical vehicle 800 (FIGS. 25A & 25B), hand 900(FIG. 27), tool 1300 (FIG. 29A) and forceps tool 1313 (FIG. 29C).

As seen in FIG. 67D, following a of the bone graft 2339, there takesplace machining of a top surface 2660 of bone graft 2339 flush with theremainder of top surface 2335 of end plate 2336, typically employingsurgical vehicle 700 (FIGS. 23A & 23B), hand 900 (FIG. 27), tol 1301(FIG. 29B) and milling head 1032 (FIG. 28D).

It is appreciated that following completion of the bone graft, any ofthe procedures described hereinabove with reference to FIGS. 50B-50E maybe carried out.

It is also appreciated that the reconstruction of a facing end plate2336 for scoliosis treatment may be substantially identical to,symmetrical with and substantially spatially matched to thereconstruction of end plate 2336 described hereinabove. Alternatively,only one end plate in a pair of facing vertebra may be so treated,depending on the extent of the disease.

Reference is now made specifically to step D of the flowchart of FIG.39D, to step B of the flowchart of FIG. 46C, FIG. 68, FIGS. 69A-69C,FIGS. 70A-70F, 71A & 71B and 72A & 72B, which illustrates the stepsbeing carried out in the physical environment of the operation.

The end plates 2024 and 2025 of respective vertebra 2004 and 2005 aremachined preferably using surgical vehicle 700 (FIGS. 23A & 23B), hand900 (FIG. 27) and milling tool 1300 (FIG. 29A) and 1301 (FIG. 29B) andmilling heads 1002 (FIG. 28A), 1032 (FIG. 28D) and 1042 (FIG. 28E) asrequired to the final real time starting operation plan as modifiedinteractively in real time by the operator using inputs inter alia fromone or more of sensors 532 associated with illuminators 533 (FIG. 20).

As discussed hereinabove with reference to FIGS. 52A, 52B aid 52C aninitial milling stage, show in FIG. 68, preferably employs surgicalvehicle 700 (FIGS. 23A & 23B) hand 900 (FIG. 27), tool 1301 (FIG. 29B)and milling head 1032 (FIG. 28D) to prepare the end plate for subsequentmatching of a recess 2402 for one type of implant comprising a generally“bean shaped” inflatable pillow, such as that described hereinbelow withreference to FIG. 73A-75B.

FIG. 69A shows that in the course of the subsequent milling stages, thegenerally central ion 2404 of the top surface 2400 of end plate 2025 ismilled preferably using surgical vehicle 700 (FIGS. 23A & 23B) hand 900(FIG. 27), tool 1300 (FIG. 29A) and milling head 1002 (FIG. 28A) toprovide generally smooth milled surface 2406 having recess 2402 formedgenerally at the center thereof.

FIG. 69B shows an alternative wherein generally central region 2404 ofthe top surface 2400 of end plate 202S is milled preferably usingsurgical vehicle 700 (FIGS. 23A & 23B) hand 900 (FIG. 27), tool 1300(FIG. 29A) and milling head 1002 (FIG. 28A) to provide a generallysmooth milled surface 2406 having a channel 2610 and having recess 2402formed generally at the center thereof. Channel 2610 is provided toaccommodate an implant, two types of which are described hereinbelowwith reference to FIGS. 75A & 75B.

FIG. 69C shows an alternative wherein generally central region 2404 ofthe top surface 2400 of end plate 2025 is milled preferably usingsurgical vehicle 700 (FIGS. 23A & 23B), hand 900 (FIG. 27) tool 1300(FIG. 29A) and milling head 1002 (FIG. 28A) to provide a generallysmooth milled surface 2406 having a channel 2671 and having a generallyoval recess 2672 formed generally at the center thereof as an extensionof channel 2671. Channel 2671 is provided to accommodate an implantassembly which is described hereinbelow with reference to any of FIGS.100A-100E and FIGS. 101A-101E.

FIG. 70A shows that further in the course of the milling stage,generally central region 2404 of the top surface 2400 of end plate 2025is machined preferably using surgical vehicle 700 (FIGS. 23A & 23B),hand 900 (FIG. 27), tool 1300 (FIG. 29A) and milling head 100 (FIG. 28A)to provide peripheral channel 2408 surrounding recess 2402 in generallysmooth milled surface 2406.

FIG. 70B shows the alternative corresponding to FIG. 69B, whereinperipheral channel 2408 surrounding recess 2402 is formed in generallysmooth milled surface 2406 having channel 2610.

FIG. 70C shows another alternative wherein, further in the course of themilling stage, generally central region 2404 of the top surface 2400 ofend plate 2025 is further machined preferably using surgical vehicle 700(FIGS. 23A & 23B), hand 900 (FIG. 27), tool 1300 (FIG. 29A) and millinghead 1002 (FIG. 28A) to provide a pair of peripheral channels 2673 and2674 surrounding recess 2402 in generally smooth milled surface 2406.

FIG. 70D shows the alternative corresponding to FIG. 70C, wherein, inperipheral channels 2673 and 2674 surrounding recess 2402 are formed ingenerally smooth milled surface 2406 having channel 2610.

FIG. 70E shows the alternative corresponding to FIG. 69C, whereinperipheral channel 2408 surrounding recess 2672 is formed in generallysmooth milled surface 2406 having channel 2671.

FIG. 70F shows the alternative corresponding to FIG. 70C, wherein, inaddition to peripheral channels 2673, there is provided a nearlyperipheral channel 2675, both ends of which extend to an edge of the endplate 2025.

Reference is now made to FIGS. 71A and 71B, which are illustrations oftwo alternative cross-sectional configuration for a peripheral channelin the embodiment of FIGS. 70A and 70B. FIG. 71A a peripheral channel2676 having a generally semicircular cross-sectional configuration,while FIG. 71B illustrates a peripheral channel 2678 having a keystoneundercut cross-sectional configuration.

Reference is now made to FIGS. 72A and 72B, which are illustrations oftwo alternative cross-sectional configurations for a pair of peripheralchannels in the embodiments of FIGS. 70C and 70D. FIG. 72A illustratesperipheral channels 2680 and 2682, both having a generally semicircularcross-sectional configuration, while FIG. 72B illustrates peripheralchannels 2684 and 2686, each having a keystone undercut cross-sectionalconfiguration.

It is appreciated that the machining of end plate 2024 is preferablysubstantially identical, substantially symmetrical with andsubstantially spatially matched to the above-described machining of endplate 2025.

Reference is now made specifically to step E of the flowchart of FIG.39D, to step C of the flowchart of FIG. 46C, to FIGS. 73A-75 whichillustrate various inflatable implants, FIGS. 76A-78D which illustratevarious disc replacement implants, FIGS. 79-81C which illustrateequipment used in insertion and inflation of the implants, and FIGS.82A-85B, which illustrate insertion and inflation of the implants in thephysical environment of the operation.

Reference is now made to FIGS. 73A, 73B, 73C, 73D, 73E, 73F, 73G and 73Hand FIGS. 74A, 74B, 74C, 74D, 74E, 74F, 74G and 74H, which aresimplified illustrations of eight variations of an inflatable implantconstructed and operative in accordance with a preferred embodiment ofthe present invention.

FIGS. 73A and 74A illustrate one preferred embodiment of a generally“bean shaped” inflatable implant 2480 (FIG. 53B), this embodiment beingdesignated by reference numeral 2700. Inflatable implant 2700 ispreferably formed of a mechanically suitable, biologically compatibleelastomer such as polyurethane by conventional blow molding techniques,preferably having integrally formed a conventional inflation valve 2701.

The bean shaped configuration is preferred because it generallycorresponds to the cross sectional configuration of the end plates 2024and 2025 of the vertebra. For the purposes of ease of described, theouter surface of inflatable implant 2700 is considered herein as havingfirst and second slightly curved generally planar surfaces 2702 and 2704and first and second intermediate edge surfaces 2706 and 2708, it beingunderstood that edge surfaces 2706 and 2708 are joined together so as todefine a complete peripheral edge surface and are joined with surfaces2702 and 2704 in a generally seamless manner to define a smooth outersurface for the implant.

As seen particularly in FIG. 74A, the slightly curved generally planarsurfaces 2702 and 2704 and intermediate edge surfaces 2706 and 2708 arecurved to compound to the configuration of the recess 2402 formed ineach end plate for secure seating therein and optimized distribution ofpressure and forces thereon and shock absorbing.

FIGS. 73B and 74B illustrate another preferred embodiment of a generally“bean shaped” inflatable implant 2480 (FIG. 53B), this embodiment beingdesignated by reference numeral 2710. Inflatable implant 2710 may begenerally similar to inflatable implant 2700 with the addition of amulti-coil spiral outwardly extending rib 2712 located on edge surfaces2706 and 2708. Rib 2712 is preferably provided to assist in guiding theinsertion and setting of disc replacement implant 2490 (FIG. 53C) inwith the inflatable implant 2710 in certain embodiments of the inventionas described hereinbelow.

FIGS. 73C and 74C illustrate yet another preferred embodiment of agenerally “bean shaped” inflatable implant 2480 (FIG. 53B), thisembodiment being designated by reference numeral 2720. Inflatableimplant 2720 may be generally similar to inflatable implant 2710 withthe addition of a lip 2721 ont a multi-coil spiral outwardly extendingrib 2722 located on edge surfaces 2706 and 2708. Rib 2722, having lip2721, is preferably provided to enhance locking engagement of discreplacement implant 2490 (FIG. 53C) in engagement with the inflatableimplant 2720 in certain embodiments of the invention as describedhereinbelow in FIGS. 76B & 77B and 98B.

FIGS. 73D and 74D illustrate still another preferred embodiment of agenerally “bean-shaped” inflatable implant 2480 (FIG. 53B), thisembodiment being designated implant 2720 with the replacement of lip2721 by a protrusion 2731, integrally inflatable implant 2720 with thereplacement of lip 2721 by a protrusion 2731, integrally formed at theouter edge of a multi-coil spiral outwardly extending rib 2731 locatedon edge surfaces 2706 and 2708. Rib 2732 having protrusion 2731 ispreferably provided to enhance locking engagement of disc replacementimplant 2490 (FIG. 53C) in engagement with the inflatable implant 2730in certain other embodiments of the invention as described hereinbelowin FIGS. 76C & 77C and 98C.

FIGS. 73E and 74E illustrate yet another prefixed embodiment of agenerally “bean shaped” inflatable implant 2480 (FIG. 53B), thisembodiment being designated by reference numeral 2733. Inflatableimplant 2733 may be generally similar to inflatable implant 2730 withthe addition of a lead 2734 coiled about edge surfaces 2706 and 2708,preferably between adjacent ribs 2732 interiorly of protrusions 2731.

Coiled lead 2734 preferably is formed with engagement sockets 2735 and2736 at opposite ends thereof. One of sockets 2735 may be attached to aforward end of a flat disc replacement coil 2490, while the other socket2736 is hooked onto by a suitable pulling tool, (not shown).

Coil lead 2734 is preferably provided to enhance the ease of insertionof the flat disc replacement coil 2490 by obviating the need for windinga lead portion thereof about inflatable implant 2480. It is appreciatedthat when coiled lead 2734 is employed, the flat disc replacement coil2490 may be provided without a lead portion or with a relatively shortlead portion which may be hooked onto socket 2736.

FIGS. 73F and 74F illustrate yet another preferred embodiment of agenerally “bean-shaped” inflatable implant 2480 (FIG. 53B), thisembodiment being designated by reference numeral 2737.

Inflatable implant 2737 may be generally similar to inflatable implant2730 with the modification that whereas in implant 2730, the entire rib2732 is of generally uniform width, in implant 2737 correspondingmutually overlapping rib portions 2738, 2739 and 2740 are of differingwidths, such that respective protrusions 2741, 2742 and 2743, integrallyformed at the outer edges thereof, do not overlie each other. Thus, whenthe implant 2737 is compressed, the protrusion 2741, 2742 and 2743 donot ad thickness as in the case of implant 2730.

FIGS. 73G and 74G illustrate still another preferred embodiment of agenerally “bean-shaped” inflatable implant 2480 (FIG. 53B), thisembodiment being designate by reference numeral 2744. Inflatable implant2744 may be generally similar to inflatable implant 2737 with themodification that whereas in implant 2737, the rib portions 2738, 2739and 2740 have monotonically stepped increased width; in implant 2744,corresponding rib portions 2745, 2746 and 2748 have non-monotonicallydifferent widths, such that corresponding protrusions 2749, 2750 and2751, integrally formed at the outer edges thereof, do not overlie eachother and do not extend successively outwardly.

FIGS. 73H and 74H illustrate still another preferred embodiment of agenerally “bean shaped” inflatable implant 2480 (FIG. 53B), thisembodiment being designated by reference numeral 2752.

Inflatable implant 2752 may be generally similar to inflatable implant2730 with the modification that whereas in implant 2730, the entire rib2732 is continuous and of generally uniform width; in implant 2752, thecorresponding spiral 2753 is made up of a multiplicity of mutuallyspaced portions 2754 which are arranged such that protrusions 2755,integrally formed at the outer edges thereof, do not overlie each other.Thus, when the implant 2752 is compressed, the protrusion 2755 as wellas the spaced portions 2754 do not add thickness as in the case ofimplant 2730.

Reference is now made to FIG. 75A, which is a simplified pictorialillustration of an inflatable implant constructed and operative in awith preferred embodiment of the present invention. This implant,designated by reference numeral 2756, may be identical to any of theinflatable implants described above with reference to FIGS. 73A-74H withthe addition of an elongate inflation conduit 2757.

Conduit 2757 preferably has a cross-sectional configuration which isadapted to fit the of channel 2610 (FIG. 69B). Conduit 2757 preferablyextends to the periphery of the end plates 2024 and 2025 and enablesinflation and deflation of the inflatable implant 2756 from a locationoutside of the end plates via valve 2701.

Refers is now made to FIG. 75B, which is a simplified pictorialillustration of another inflatable implant and operative in accordancewith another preferred embodiment of the present symbol. This implantmay be identical in all relevant respects to implant 2756; describedhereinabove with reference FIG. 75A, with the addition of lead 2734(FIGS. 73E and 74E) coiled about edge surfaces 2706 and 2708.

Coiled lead 2734 preferably is formed with engagement sockets 2735 and2736 at opposite ends thereof. One of the sockets, 2735, may be attachedto a forward end of a flat disc replacement coil 2490, while the othersocket 2736 is hooked onto by a suitable pulling tool, (not shown).

As in the embodiment of FIGS. 73E and 74F, coiled lead 2734 ispreferably provided to enhance the ease of insertion of the flat discreplacement coil 2490 by obviating the need for winding a lead portionthereof about the inflatable portion of implant 2756, which is identicalto inflatable implant 2480. It is appreciated that when coiled lead 2734is employed, the flat disc replacement coil 2490 may be provided withouta lead portion, or with a relatively shirt lead portion which may behooked onto socket 2736.

Reference is now made to FIGS. 76A, 76B, 76C, 76D, 76E, 76F, 76G, 76H,76I, 76J, & 76K; FIGS. 77A, 77B, 77C, 77D, 77E, 77F, 77G, 77H, 77I, 77J& 77K; and FIGS. 78A, 78B, 78C, 78D, 78F, 78G, 78H, 78I, 78J & 78K,which twelve variations of a flat disc replacement coil constructed andoperative in accordance with a preferred embodiment of the presentinvention.

Referring specifically to FIGS. 76A, 77A and 78A, which illustrate afirst such variation, indicated generally by reference numeral 2758, itis seen that the flat disc replacement coil 2758 comprises a head 2759,a lead coil portion 2760, a main coil portion 2761, typically includingfour coils 2762, 2763, 2764 and 2765, having at least three differingcross-sections, and a tail portion 2766 which is preferably removablyconnected to the last coil 2765, as by a perforated conjunction 2768. Itmay be appreciated that the lead coil portion 2760 should be ofsufficient length to define a number of coils equal to the number ofcoils making up the main coil portion 2761.

It is seen that the head 2759 is preferably of a generally conicalconfiguration and preferably has a maximum cross-sectional dimensionwhich is slightly greater than the maximum cross-sectional dimension ofthe lead coil portion 2760. The lead coil portion 2760 typically has around cross-section.

In the illustrated embodiment of FIGS. 76A, 77A and 78A, coil 2762preferably has a generally omega-shaped cross-section having a centralregion 2768 including a convex rounded cross-sectional surface 2770which preferably corresponds to the cross-sectional configuration of achannel 2475 (FIG. 53A) in one of end plates 2024 and 2025 and a concaverounded cross-sectional surface 2772.

Coil 2763 preferably has a generally rectangular cross-section having acentral rounded protrusion 2774 at the center thereof, defining convexrounded cross-sectional 2776 and 2778. Convex surface 2776 is preferablyconfigured to seat in concave surface 2772.

Coil 2764 preferably has a generally omega-shaped cross-section, whichmay be a mirror-image of the cross-section of coil 2762 and has acentral region 2788 including a concave rounded cross-sectional surface2790, which preferably corresponds to the cross-sectional configurationof surface 2778, and a convex rounded cross-sectional surface 2792.

Coil 2765 preferably has a generally omega-shaped cross-section, whichmay be identical to the cross-section of coil 2764 and has a centralregion 2798 including a concave rounded cross-sectional surface 2800,which preferably corresponds to the cross-sectional configuration ofsurface 2792, and a convex rounded cross-sectional surface 2802 whichpreferably corresponds to the cross-sectional configuration of a channel2475 (FIG. 53A) in an opposite one of end plates 2024 and 2025.

Reference is now made specifically to FIGS. 76B, 77B and 78B, whichillustrate a second variation of a flat disc replacement coil, indicatedgenerally by reference general 2850, which is particularly adapted foruse together with inflatable implant 2720 (FIGS. 73C and 74C).

It is seen that the flat disc replacement of coil 2850 may be generallyidentical to flat disc replacement coil 2758 (FIGS. 76A, 77A and 78A)with the only differences being as follows:

1. The cross-sectional configuration of the main coil portion, heredesignated 2856, includes at an inner facing edge thereof a hook-likeportion 2860 which is configured to lockingly engage lip 2721 and rib2722 of inflatable implant 2720 (FIGS. 73C and 74C). The remainingstructural features of flat disc replacement coil 2850 are thereforedesignated by the same reference numerals employed in FIGS. 76A, 77A and78A.

2. At predetermined locations 2862 and 2862 on coil 2850, the coil isformed with a transverse recess which permits access to inflation valve2701 (FIG. 73A).

Reference is now made specifically to FIGS. 76C, 77C and 78C, whichillustrate a third variation of a flat disc replacement coil, indicatedgenerally by reference numeral 2950, which is particularly adapted foruse together with inflatable implant 2730 (FIGS. 73D and 74D).

It is seen that the flat disc replacement coil 2950 may be generallyidentical to flat disc replacement coil 2758 (FIGS. 76A, 77A and 78A)with the only difference being in that the cross-sectionalconfigurations of the main coil portion, here designated 2956,specifically the configurations of the coils thereof, here designated2958, 2960, 2962 and 2964 include, adjacent inner facing edges thereof,respective channel 2966, 2968, 2970, 2972, 2974 and 2976. Channels 2966,2968, 2970, 2972, 2974 and 2976 are configured to lockingly engagecorresponding surfaces of protrusion 2731 of inflatable implant 2730(FIGS. 73D & 74D).

Reference is now made specifically to FIGS. 76D, 77D and 78D, whichillustrate a fourth variation of a flat disc replacement coil, indicatedgenerally by reference numeral 3050, which is particularly adapted foruse together with inflatable implant 2710 (FIGS. 73B and 74B).

It is seen that the flat disc replacement coil 3050 may be generallyidentical to flat disc replacement coil 2950 (FIGS. 76C, 77C and 78C)with the only difference being that the integrally formed lead portion2760 is replaced by a connector 3060, coupled to a main portion 3062 ofcod 3050, via a perforated junction 3064, which may be identical toperforated junction 2768 (FIG. 76A). The connector 3060 is configuredand adapted to be readily mechanically coupled to engagement socket 2735of coiled lead 2734 of the inflatable implant described hereinbelow withreference to FIGS. 73E and 74E.

Reference is now made specifically to FIGS. 76E, 77E, and 78E, whichillustrate a fourth variation of a flat disc replacement coil, indicatedgenerally by reference numeral 3070, which is adapted for use togetherwith inflatable implant 2700 (FIGS. 73A and 74A).

It is seen that the flat disc replacement coil 3070 is characterized inthat it is formed with undercut recesses 3072 and 3074 on each of itsrespective top and bottom surfaces 3076 and 3078. Recesses 3072 and 3074typically extend substantially along the entire length of the coil 3070.

Referring specifically to FIGS. 76F, 77F, and 78F, which illustrate afifth variation, indicated generally by reference numeral 3080, it isseen that the flat disc replacement coil 3080 comprises a head 3082, alead coil portion 3084, a main coil portion 3086, typically includingcoins 3087, 3088, 3089 and 3090, having at least three differingcross-section, and a tail portion 3092 which is preferably removablyconnected to the last coil 3090, as by a perforated on 3094. It may beappreciated that the lead coil portion 3084 should be of sufficientlength to define a number of coils equal to the of coils making up themain coil portion 3086.

It is seen at the head 3082 is preferably of a generally conicalconfiguration and preferably has a maximum cross-sectional dimensionwhich is slightly greater than the maximum cross-sectional dimension ofthe lead coil portion 3084. The lead coil portion 3084 typically has around cross-section.

In the illustrated embodiment of FIGS. 76F, 77F and 78F, coil 3087preferably has a generally omega-shaped cross-section having a centralregion 3096 including an undercut convex cross-sectional surface 3098which preferably corresponds to the cross-sectional configuration of achannel 2678 (FIG. 71B) in one of end plates 2024 and 2025 and anundercut concave cross-sectional surface 3100.

Coil 3088 preferably has a generally rectangular cross-section having acentral undercut protrusion 3102 at the center thereof, defining andconvex cross-sectional surfaces 3104 and 3106. Convex surface 3104 ispreferably configured to lockingly seat in concave surface 3100.

Coil 3089 preferably has a generally omega-shaped cross-section, whichmay be a mirror-image of the cross-section of coil 3087 and has acentral region 3108 including an undercut concave cross-sectionalsurface 3110, which preferably corresponds to the cross-sectionalconfiguration of surface 3106 for locking engagement therewith, and anundercut convex cross-sectional surface 3112.

Coil 3090 preferably has a generally omega-shaped cross-section, whichmay be identical to the cross-section of coil 3089 and has a central3114 including an undercut concave cross-sectional surface 3116, whichpreferably corresponds to the cross-sectional configuration of surface3112, and an undercut convex cross-sectional surface 3118 whichpreferably corresponds to the cross-sectional configuration of a channel2678 (FIG. 71B) in an opposite one of end plates 2024 and 2025.

Reference is now made specifically to FIGS. 76G, 77G and 78G, whichillustrate a seventh variation, indicated generally by reference numeral3180. It is seen that the first disc replacement coil 3080 comprises abed 3182, a lead coil portion 3184, a main coil portion 3186, typicallyincluding four coils 3187, 3188, 3189 and 3190, having at least threediffering cross-section, and a tail portion 3192 which is preferablyremovably connected to the last coil 3190, as by a perforated junction3194.

It may be appreciated that the lead coil portion 3184 should be ofsufficient length to define a number of coils equal to the number ofcoils making up the main coil portion 3186.

It is seen that the head 3182 is preferably of a generally conicalconfiguration and preferably has a maximum cross-sectional dimensionwhich is slightly greater than the cross-sectional dimension of the leadcoil portion 3184. The lead coil portion 3184 typically has a roundcross-section.

In the illustrated embodiment of FIGS. 76A, 77G and 78G, coil 3187preferably has a generally rectangular cross-section having a firsthook-like portion 3196 at an inner, bottom facing corner thereof andhaving a second hook-like portion 3198 at an outer, top facing cornerthereof.

Coil 3188 preferably has a generally rectangular cross-section having afirst hook-like portion 3200 at an inner, bottom facing corner thereofand having a second book-like portion 3202 at an outer, top facingcorner thereof. Additionally, there is provide at an outer, bottomfacing corner of coil 3188, a hook member 3204 which is configured forlocking engagement with hook portion 3198 of coil 3187.

Coil 3189 preferably has a generally rectangular cross-section, whichmay be identical to the cross-section of coil 3188. Coil 3189 has afirst hook-like portion 3206 at an inner, bottom facing corner thereofand having a second hook-like portion 3208 at an outer, top facingcorner thereof. Additionally, there is provided at an outer, corner ofcoil 3189, a hook member 3210 which is configuration locking engagementwith hook portion 3202 of coil 3188.

Coil 3190 preferably has a generally cross-section having a firsthook-like portion 3212 at an inner, bottom facing corner thereof and, atan outer, bottom facing corner, a hook member 3214 which is configuredlocking engagement with hook portion 3208 of coil 3189.

Reference is now made specifically to FIGS. 76H, 77H and 78H, whichillustrate a eighth variation, indicated generally by reference numeral3280. It is seen that the flat disc replacement coil 3280 comprises ahead 3282, a lead coil portion 3284, a main coil portion 3286, typicallyincluding four coils 3287, 3288, 3289 and 3290, having at least twodiffering cross-section and a tail portion 3292 which is preferablyremovably connected to the last coil 3290, as by a perforated on 3294.It may be appreciated that the lead coil portion 3284 should be ofsufficient length to define a number of coils equal to the number ofcoils making up the main coil portion 3286.

It is seen that the head 3282 is preferably of a generally conicalconfiguration and preferably has a cross-sectional dimension which isslightly greater than the maximum cross-sectional dimension of the leadcoil portion 3284. The lead coil portion 3284 typically has a roundcross-sectional.

In the illustrated embodiment of FIGS. 76H, 77H and 78H, coil 3287preferably has a generally rectangular cross-section having a centralsomewhat slanted recess 3296 at a top facing surface thereof.

Coil 3288 may be identical to coil 3287 and preferably has preferablyhas a generally rectangular cross-section having a central somewhatslanted recess 3298 at a top facing surface thereof.

Coil 3289 may be identical to coils 3287 and 3283 and preferably haspreferably has a generally rectangular cross-section having a centralsomewhat slanted recess 3300 at a top facing surface thereof.

It should be appreciated that the provision of recesses 3296, 3298 and3300 in respective coils 3287, 3288 and 3289 provides enhancedflexibility thereto. The existence and amount of slant may beappreciated by the precise degree and location of desired flexibility.

Coil 3290 preferably has a generally rectangular cross-section.

Reference is now made specifically to FIGS. 76I, 77I and 78I, whichillustrate a ninth variation, indicated generally by reference numeral3380. It is seen that coil portion 3386, typically including four coils3387, 3388, 3389 and 3390 having at least three differing longitudinalcross-sections, and a tail portion 3392 which is preferably removablyconnected to the main coil portion 3386, as by a perforated junction3394. It may be appreciated that the lead coil portion 3384 should be ofsufficient length to define a number of coils equal to the number ofcoils making up the main coil portion 3386.

It is seen that the head 3382 is preferably of a generally conicalconfiguration and preferably has a maximum cross-sectional dimensionwhich is slightly greater than the maximum cross-sectional dimension ofthe lead coil portion 3384. The lead coil portion 3384 typically has around cross-section.

In the illustrated embodiment of FIGS. 76I, 77I, 78I, main coil portion3386 has generally rectangular cross-section of two differing widthsalong its length, as seen in FIG. 77I. The main coil portion 3386, is,however, corrugated, as seen clearly in FIG. 78I.

In the illustrated embodiment of FIGS. 76I, 77I and 78I, coil 3387preferably has a generally rectangular longitudinal cross-section havinga generally flat bottom facing surface 3396 and a toothed top facingsurface 3398.

Coil 3388 preferably has a generally rectangular cross-section havingtoothed bottom and top facing surfaces 3400 and 3402. Surface 3400 isconfigured to seat in surface 3398.

Coil 3389 may be identical to coil 3388 and preferably has a generallyrectangular cross-section having toothed bottom and top surfaces 3404and 3406. Surface 3404 is configured to seat in surface 3402.

Coil 3392 preferably has a generally rectangular cross-section and is amirror image of coil 3387, having a toothed bottom facing surface 3408and a generally flat top icing surface 3410. Surface 3408 is configuredto seat in surface 3406.

Reference is now made specifically to FIGS. 76J, 77K and 78J, whichillustrate a tenth variation, indicated generally by reference numeral3480. It is seen that the flat disc replacement coil 3480 comprises ahead 3482, a lead coil portion 3484, a main coil portion 3486, typicallyincluding four coils 3487, 3488, 3489 and 3490; having at least threediffering cross-section as seen in FIG. 77J and at least three differinglongitudinal cross-sections as seen in FIG. 78J, and a tad portion 3492which is preferably removably connected to the main coil portion 3486,as by a perforated junction 3494. It may be appreciated that the leadcoil portion 3484 should be of sufficient length to define a number ofcoils equal to the number of coils making up the main coil portion 3486.

It is seen that the head 3482 is preferably of a generally conicalconfiguration and preferably has a maximum cross sectional dimensionwhich is slightly greater than the maximum cross-sectional dimension ofthe lead coil portion 3484. The lead coil portion 3484 typically has around cross-section.

In the illustrated embodiment of FIGS. 76J, 77J and 78J, main coilportion 3486 is formed with teeth and corresponding recesses which donot extend over the width of the coil and thus serve to mutually alignthe individual coils in three dimensions.

As seen in FIG. 77J, coil 3487 preferably has a generally rectangularcross-section having a generally fin bottom facing surface 3496 and atop facing surface 3498 having a recess 3500 extending along the lengththereof.

Coil 3488 preferably has preferably has a generally rectangularcross-section having a bottom facing surface 3502 having a protrusion3504 extending along the length thereof, which is configured to seat inrecess 3500. Coil 3488 also has a top facing surface 3506 having arecess 3508 extending along the length thereof.

Coil 3489 may be identical to coil 3488 and preferably has a generallyrectangular section having a bottom icing surface 3510 having aprotrusion 3512 extending along the length thereof, which is configuredto seat in recess 3508. Coil 3489 also has a top facing surface 3514having a recess 3516 extending along the length thereof.

Coil 3490 preferably has a generally rectangular cross-section, having abottom facing surface 3518 having a protrusion 3520 extending along thelength thereof for seating in surface 3516 and a generally flat topfacing surface 3522.

The longitudinal cross section shown in FIG. 78J may be identical tothat shown in FIG. 78I.

Reference is now made specifically to FIGS. 76K, 77K and 78K whichillustrate an eleventh variation, indicated generally by referencenumeral 3580. It is seen that the flat disc replacement coil 3580comprises a head 3582, a lead coil portion 3584, a main coil portion3586, typically including four coils 3587, 3588, 3589 and 3590, havingat least three differing typical cross-sections, and a tail portion 3592which is preferably removably connected to the main coil portion 586, asby a perforated junction 354. It may be appreciated that the lead coilportion 3584 should be of sufficient length to define a number of coilsto the number of coils making up the main coil portion 3586.

It is seen that the head 3582 is preferably of a generally conicalconfiguration and preferably has a maximum cross-sectional dimensionwhich is slightly greater than the maximum cross-sectional dimension ofthe lead coil portion 3584. The lead coil portion 3584 typically has around cross-section.

In the illustrated embodiment of FIGS. 76K, 77K and 78K, main coilportion 3486 is formed on opposite surfaces thereof with opposing“VELCRO”® type engagement elements of two different types which aredesigned for secure engagement therebetween.

Coil 3587 preferably has a generally rectangular cross-section having agenerally flat bottom facing surface 3596 and a top facing surface 3598having a first type of engagement elements 3600 thereon.

Coil 3588 preferably has preferably has a generally cross-section havinga bottom facing surface 3602 having a second type of elements 3604thereon which are configured for “VELCRO”® type engagement with thefirst type of engagement elements 3600. Coil 3588 also has a top facingsurface 3606 having the first type of engagement elements 3600 thereon.

Coil 3589 may be identical to coil 3588 having a bottom facing surface3608 having the second type of engagement elements 3604 thereon whichare configured for “VELCRO”® type engagement with the first type ofengagement 3600. Coil 3589 also has a top facing surface 3610 having thefirst type of elements 3600 thereon.

Coil 3590 preferably has a generally rectangular cross-section, having abottom facing 3612 having the second type of engagement elements 3604thereon which are configured for “VELCRO”® type engagement with thefirst type of engagement elements 3600. Coil 3590 also has a top facingsurface 3614 which may be flat.

It is appreciated that any of the coils described herein with referenceto FIGS. 76A-76C, 76E-76K, 77A-77C, 77E-77K, 78A-78C and 78E-78K may beconstructed and employed in a leadless configuration, such as thatdescribed hereinabove with reference to FIGS. 76D, 77D and 78D.

Reference is now made to FIGS. 79, 80A and 80B which illustrate a flatdisc replacement coil transporter and dispenser 4000 constructed andoperative in accordance with a preferred embodiment of the presentinvention. The flat disc replacement coil transporter and dispenser 4000preferably includes a housing 4002 which is preferably formed of firstand second generally elongate joined housing subassemblies 4004 ad 4006.

The housing 4002 preferably comprises a plurality of mutuallyarticulated portions 4008, 4010 and 4012, which are preferably joined byflexible couplings 4014 and 4016. It may thus be appreciated that eachof housing subassemblies 4004 and 4006 preferably includes three housingsub-portions, designated respectively as 4018, 4020 and 4022 for housingsubassembly 4004 and 4028, 4030 and 4032 for housing subassembly 4006.

Housing portion 4008 is preferably the forward facing housing portionand includes a forward coil driving assembly 4040 mounted on housingsub-portion 4018 and comprising an electric motor 4042, which iscontrolled by multi-functional contoller 253 (FIG. 7) and which drives aroller 4044, forming part of a three-roller pinch roller assembly 4046which also includes rollers 4048 and 4050.

As seen particularly in FIG. 80A, rollers 4044, 4048 and 4050 arepreferably configured to have cross-sections which correspond to thecross-sectional configurations of both the lead portion 4051 and themain portion 4052 of the particular coil 4060 which is employed.

Rearwardly of forward coil driving assembly 4040 there is preferablyprovided a coil feeder 4053 which feeds a coil 4060 into driving withforward coil driving assembly 4040. Coil 4060 may be any suitable coil,such as those described hereinbelow with reference to any of FIGS.76A-76C, 76E-76K, 77A-77C, 77E-77K 78A-78C an 78E-78K.

As seen particularly in FIG. 80B, feeder 4053 has the generalconfiguration of a funnel.

Located on a front face 4070 of housing portion 4008 and mounted on afront face 4072 of housing sub-portion 4018 and on a front face 4074 ofhousing sub-portion 4028 are quick connection mounting assemblies,respectively designated by reference numerals 4076 and 4078, which aresuitable for mounting of hands 900, of the type described above withreference to FIG. 27.

Front face 4070 is preferably formed with a coil outlet aperture 4080,which is defined by the respective front faces 4072 and 4074 ofsub-portion 4018 and 4028. Coil outlet a 4080 preferably has aconfiguration which corresponds to the maximum cross-sectionaldimensions of the particular coil 4060 that is being employed.

Housing sub-portion 4028 is preferably fined with a vehicle dock 4082for removable docking thereto of a surgical vehicle, preferably vehicle800 (FIGS. 25A & 25B).

Intermediate housing portion 4010, disposed of forwardly facing housingportion 4008 and flexibly coupled thereto by means of flexible coupling4014, preferably includes an intermediate coil driving assembly 4090mounted on housing sub-portion 4020. Assembly 4090 may be identical inall relevant respects to assembly 4040 and its components are identifiedby identical reference numerals.

Rearwardly of intermediate coil driving assembly 4090 there ispreferably provided a coil feeder 4092, which may be identical to feeder4053 and which feeds coil 4060 into driving engagement with intermediatecoil driving assembly 4090.

Housing sub-portion 4030, which forms part of intermediate housingportion 4010, is preferably formed with a vehicle dock 4094 forremovable docking thereto of a surgical vehicle, preferably vehicle 800(FIGS. 25A & 25B). Dock 4094 may be identical in all relevant respectsto dock 4082.

Rearward housing portion 4012, disposed rearwardly of intermediatehousing portion 4010 and flexibly coupled thereto by means of flexiblecoupling 4016, includes rearward housing sub-portions 4022 and 4032which together preferably define a coil storage bay 4096 for storage ofcoil 4060 in a coiled orientation therein.

It is appreciated that the overall configuration of the flat discreplacement coil transporter and dispenser 4000 is such that it does notfill all of the space in the third cannula subassembly and does notengage all of the tracks. In a preferred embodiment of the presentinvention, sufficient room is left free inside the third cannulasubassembly to enable operation of a surgical vehicle 800, supported ona track 504 (FIG. 22), alongside the flat disc replacement coiltransporter and dispenser 4000.

Preferably, the flat disc replacement coil transporter and dispenser4000 also defines longitudinal recesses 4098, 4100, 4102, 4104, 4106 &4108 for mounting engagement with respective tracks 504, 508, 504, 506,504 & 506 of the outer portion 500 of the third cannula subassembly 176,as seen in FIG. 22.

Reference is now made to FIGS. 81A, 81B, 81C & 81D, which are pictorialillustrations of four different tools useful in association with theflat disc replacement coil transporter and dispenser of FIG. 79. Thetools of FIG. 81A, 81B, 81C & 8D are preferably mounted onto hands 900,such as the hand 900 shown in FIG. 27 which is typically mounted ontoone or more of quick connection mounting assemblies 4076 and 4078 on thefront face 4070 of the flat disc replacement coil transporter anddispenser 4000 (FIG. 79) and/or onto a vehicle, such as vehicle 800.

FIG. 81A illustrates a coil orienting tool, here designated by referencenumeral 4200, which may be employed in association with universal hand900 and removably and replaceably coupled to tool engagement element 930thereof (FIG. 27). Tool 4200 typically comprises a pair of elements 4202and 4204, having respective inwardly facing surfaces 4206 and 4208 whichare configured to correspond to the cross-sectional configuration of themain portion 4052 of the particular coil 4060 which is employed.

FIG. 81B illustrates a coil orienting and coating tool, here designatedby reference numeral 4220, which may be employed in association withuniversal hand 900 and removably and replaceably coupled to toolengagement element 930 thereof (FIG. 27).

Tool 4220 typically comprise a pair of elements 4222 and 4224, havingrespective inwardly facing 4226 and 4228 which are configured to definea coil coating passage 4229 having a cross-section corresponding to thecross-sectional configuration of the main portion 4052 of the particularcoil 4060 (FIG. 79) which is employed.

The tool of FIG. 81B differs from that of FIG. 81A in that it comprisesa liquid coating supply conduit 4230 which communicates with outletorifices 4232, formed on at leas one of surfaces 4226 and 4228 forsupplying a liquid coating material to the coil 4060 as the coil pausestherethrough.

The liquid coating material may be an in situ polymerizable polymerwhich, when polymerized, becomes an elastomeric bond substrate. Apreferred material is a flowable polyurethane commercially availablefrom Advanced Bio-Surfaces, Inc. of Minnetonka, Minn., U.S.A. Anotherpreferred material may be a biomaterial described on a web site ofProtein Polymer Technologies, Inc. identified as http://www.ppti.com.

It is also appreciated that such biomaterials or materials similarthereto may advantageously be used to form some or all of the flowablematerials employed in the present invention. Such biomaterials may beemployed, in certain circumstances together with biological materialsearlier removed from the patient, such as during disc suctioning.

FIG. 81C illustrates a coil forceps tool 4240 which may be employed inassociation with universal hand 900 and removably and replaceablycoupled to tool engagement element 930 thereof (FIG. 27). Coil forcepstool 4240 typically comprises a base 4242 onto which is preferablyfixedly mounted one forceps finger pair 4244 and a siding finger 4245.

A second forceps finger pair 4246 is mounted for selectable positioningwith respect to forceps finger pair 4244, such as in an off-axisarrangement on a drive shaft 4248 of a motor 4250 which may becontrolled directly by multi-functional controller 253 (FIG. 7).

FIG. 81D illustrates a laser coil cutting tool, here designated byreferences numeral 4260, which may be employed in association withuniversal hand 900 and removeably and replaceably coupled to toolengagement 930 thereof (FIG. 27). Tool 4260 typically comprises asuitable laser 4262 coupled to an energy outlet head 4264 as by means ofan optical fiber assembly 4266.

Reference is now made to FIGS. 82A, 82B, 83A & 83B which illustrateinsertion and inflation of an embodiment of an inflatable implantbetween facing end plates of adjacent vertebrate. FIGS. 82A and 82B aresimplified pictorial illustrations of insertion of a first embodiment ofinflatable implant 4300, which may be identical to inflatable implant2480 (FIG. 53B), between facing end plates of adjacent vertebrate. FIGS.83A and 83B are sectional illustrations taken along respective linesLXXXIIIA-LXXXIIA AND LXXXIIIB-LXXXIIIB in FIGS. 82A and 82B.

As seen in FIGS. 82A, 82B, 83A & 83B, an inflatable implant 4300 isinserted, preferably using a plurality of surgical vehicles 800 (FIGS.25A & 25B), hands 900 (FIG. 27), a pair of pick and place tools 1322(FIG. 29E) an inflation tool 1350 (FIG. 29F) and a gauging tool 1360(FIG. 29G) according to the final read time starting operation plan asmodified interactively in real time by the operator using inputs interalia from one or more of sensors 532 associated with illuminators 533(FIG. 20).

In accordance with a preferred embodiment of the present invention,traction may be applied to the vertebrae in a controlled manner at thisstage, preferably by operation of electric motor 118 (FIG. 1) operatedby controller 119 (FIG. 1).

It is seen that following completion of end plate reconstruction andreinforcement to the extent required, as well as suitable end platemachining, as described hereinabove with reference to FIGS. 65A-72B, theinflatable implant 4300 is inserted between end plates 2024 and 2025 ofrespective adjacent vertebrate 2004 and 2005 (FIG. 48) in recess 2402(FIG. 69A).

Insertion of the implant 4300 between end plates 2024 and 2025preferably employs a pair of pick and place tools 1322 or 1324 (FIG.29E), each preferably mounted on a surgical vehicle 800 (FIGS. 25A &25B) via hand 900 (FIG. 27), as well as an inflation tool 1350 (FIG.29F), preferably mounted on a surgical vehicle 800 (FIGS. 25A & 25B) viahand 900 (FIG. 27). Following in of the implant 4300, the pick and placetools are no longer required and may be removed.

Inflatable implant 4300, upon insertion thereof between end plates 2024and 2025 as shown in FIG. 83A, is somewhat deflated. Subsequentinflation of the implant 4300 by means of inflation tool 1350 causesexpansion implant 4300 preferably to the configuration shown in FIGS.82B and 83B. Gauging tool 1360 is preferably employed, as shown in FIGS.82B and 83B, for the measuring extent of inflation of the implant 4300and/or the resulting separation between adjacent vertebrae.

Alternatively or additionally marks 4370 may be placed on implant 4300and/or on adjacent vertebrate to enable the orientation thereof to besensed using one or more of sensors 532 which may be associated withilluminator 533 (FIG. 20).

The information derived from the gauging tool 1360 and/or from sensors532 may be advantageously supplied to computer 148 (FIG. 2) forconfirmation purposes and also for interactive modification of the finalreal time starting operation plan.

Reference is now made to FIGS. 84A and 84B, which are simplifiedpictorial illustrations of insertion of a second embodiment ofinflatable implant, designated by reference of insertion of a secondembodiment of inflatable implant, designated by and 85B, which aresectional illustrations taken along lines LXXXVA-LXXXVA andLXXXVB-LXXXVB respectively in FIGS. 84A and 84B.

As seen in FIGS. 84A, 84B, 85A and 85B, the inflatable implant 4400comprises a generally bean-shaped inflatable portion 4402, which istypically identical in shape to implant 4300. As distinguished fromimplant 4300, implant 4400 also includes a protruding inflation conduit4404 which has a cross-sectional configuration matching that of channel2610 (FIG. 69B). The structure of implant 4400 readily enablesselectable inflation and deflation of implant 4400 during the remainderof the operation without interference from other implants subsequentlyinserted surrounding implant 4400.

It is seen that following completion of end plate reconstruction andreinforcement to the extent required and suitable end plate machiningthe inflatable implant 4400 is inserted between end plates 2024 and 2025of respective adjacent vertebrate 2004 and 2005 (FIG. 48) in recess 2402(FIG. 52B), with conduit 4404 being seated in channel 2610.

Insertion of the implant 44 between end plates 2024 and 2025 andsubsequent inflation thereof preferably employs the same set ofvehicles, hands and tools used for insertion and inflation of implant4300 and similar techniques.

Reference is now made to FIGS. 86 and 86B, which are respectivepictorial and partially cut-away pictorial views illustrating a firststage in the insertion of a flat disc replacement coil, such as coil2758 (FIGS. 76A & 76B), in accordance with a first embodiment of thepresent invention.

As seen in FIGS. 86A and 86B, the first stage of insertion of coil 2758preferably employs the flat disc replacement coil transporter anddispenser 4000 (FIG. 79) having a pair of hands 900 mounted on quickconnection mounting assemblies 4076 and 4078 thereof.

A surgical vehicle 800 is located alongside flat disc replacement coiltransporter and dispenser 4000 and has a hand 900 mounted thereon. Coilforceps tool 4240 is mounted on hand 900 which is in turn mounted onsurgical vehicle 800. Mounted on one of hands 900 which are in turnmounted on flat disc coil transporter and dispenser 4000, is either oneof tools 4200 and 4220 shown in respective FIGS. 81A and 81B. Theremaining hand 900 supports a dispenser tool 1319 (FIG. 29D).

The forward and intermediate coil driving assemblies 4040 and 4090 ofthe flat disc replacement coil transporter and dispenser 4000 areoperated in response to control signals from multi-functional controller253 to push the lead portion 2760 forwardly relative to transporter anddispenser 4000, via tool 4200.

Due to its pre-coiled configuration, the lead coil portion 2760 tends tocoil about the inflatable implant 4300, as seen in FIG. 86A. Coilforceps tool 4240 is shown ready to engage coil head 2759 using fingerpairs 4244 (not shown) and 4246 and guiding finger 4245 (not shown) forpulling coil head 2759 and assisting in coiling of the lead coil portion2760 about the inflatable implant 4300.

As seen in FIG. 86B, at this stage, the main coil portion 2761 of coil2758 mainly remains coiled in bay 4096, the forward part of the mainportion 2761 extending forwardly of bay 4096 and being about to engagecoil feeder 4092, following the lead coil portion 2760, which is engagedby both intermediate and forward coil driving assemblies 4040 and 4090.

Reference is now made to FIGS. 87A and 87B, which are respectivepictorial and partially cut-away pictorial views illustrating a secondstage in the insertion of a flat disc replacement coil, such as coil2758 (FIG. 76A), in accordance with a first embodiment of the presentinvention. As seen in FIGS. 87A and 87B, the second stage of insertionof coil 2758 preferably employs the same equipment as that employed inthe first stage illustrated in FIGS. 86A and 86B for continued coilingof the lead coil portion 2760 about inflatable implant 4300 as shown.

Preferably, tool 4200 is gradually repositioned so as to guide the leadcoil portion 2760 for producing a desired coil configuration. At thisstage, coil forceps tool 4240 engages the lead coil portion 2760 and thecoil head 2759 using finger pairs 4244 (not shown) and 4246 and guidingfinger 4245 (not shown) for pulling them and assisting in continuedcoiling of the lead coil portion 2760 about inflatable implant 4300.

As seen in FIG. 87B, at this stage, the main coil portion 2761 of coil2758 extends forwardly of bay 4096 through coil feeder 4092, followingthe lead coil portion 2760, and through intermediate coil drivingassembly 4090.

Reference is now made to FIGS. 88A and 88B, which are respectivepictorial and partially cut-away pictorial views illustrating a thirdstage in the insertion of a flat disc replacement coil, such as coil2758 (FIG. 76A), in accordance with a first embodiment of the presentinvention. As seen in FIGS. 88A and 88B, the third stage of insertion ofcoil 2758 preferably employs the same equipment as that employed in thefirst stage illustrated in FIGS. 86A and 86B for continued coiling ofthe lead coil portion 2760 about inflatable implant 4300 as shown.

Additionally dispenser tool 1319 is preferably employed in order toprovide a flowable bonding material to the main coil portion 2761 as itis being coiled about inflatable implant 4300. Alternatively, tool 4220may be employed instead of tool 4200 in order to coat the main coilportion 2761 with the bonding material and thus possibly to obviate theneed for operation of dispenser tool 1319. At this stage coil forcepstool 4240 engages and pulls coil head 2759 rearwardly, thus assisting incoiling of the main coil portion 2761 about the inflatable implant 4300.

As see in FIG. 88B, at this stage, the main coil portion 2761 of coil2758 extends through the entire extend of transporter and dispenser 4000inter alia via coil feeders 4092 and 4053 and intermediate and forwardcoil driving assemblies 4090 and 4040.

Reference is now made to FIGS. 89A and 89B, which are respectivepictorial and partially cut-away pictorial views illustrating a fourthand final stage in the insertion of a flat disc replacement coil, suchas coil 2758 (FIG. 76A), in accordance with a first embodiment of thepresent invention. As seen in FIGS. 89A and 89B, the fourth stage ofinsertion of coil 2758 preferably employs the same equipment as thatemployed in the first three stages illustrated in FIGS. 86A-88B forcompleting the coiling of the main coil portion 2761 about inflatableimplant 4300 as shown.

It is seen that the coil head 2759 and most of the lead coil portion2760 have been retracted into the third cannula subassembly at thisstage and coil forceps tool 4240 has been removed and disengaging fromhand 900. A laser ating tool 4260 (FIG. 81D) is now mounted on hand 900,which is in turn mounted on surgical vehicle 800 and is preferablyemployed for cutting tail portion 2766 from the coiled main coil portion2761, preferably at junction 2768. Laser cutting tool 4260 may also beemployed for cutting lead coil portion 2760 from the c=led main coil2761.

Turning to FIG. 89B, it is seen that only the tail portion 2766 remainsin the transporter and dispenser 4000 and is appropriately tensioned andpositioned thereby.

Following this stage, additional bonding material may be added asappropriate and the inflatable implant 4300 may be slightly deflated asappropriate and at an appropriate time with reference, inter alia toremoval of the third cannula subassembly, hands and tools from theoperation site.

Reference is now made to FIGS. 90A and 90B which illustrate deflation ofinflatable implant 4300 following insertion of the flat disc replacementcoil. FIG. 90A illustrates inflatable implant 4300 and flat discreplacement coil 2850 (FIGS. 76B, 77B and 78B) having recesses atlocations 2862 and 2864. An inflation tool 1350 (FIG. 29F), havingassociated pressurized fluid supply inlet tube 1352, engages inflationvalve 2701 via the recesses at locations 2862 and 2864 and vents some ofthe pressurized fluid via tube 1352.

FIG. 90B illustrates inflatable implant 2756 having conduit 2757 (FIG.75A) and flat disc replacement coil 2758 (FIGS. 76A, 77A and 78A). Aninflation tool 1350 (FIG. 29F), having associated pressurized fluidsupply inlet tube 1352, engages inflation at valve 2701 at the extremeend of conduit 2757, adjacent the periphery of end plates 2024 and 2025and vents some of the pressurized fluid via tube 1352.

Reference is now made to FIG. 91 which illustrates a flat discreplacement coil transporter and dispenser 4500 constructed andoperative in accordance with another preferred embodiment of the presentinvention for use with a headless flat disc replacement coil, such ascoil 3050 (FIG. 76D). The flat disc replacement coil transporter anddispenser 4500 preferably includes a housing 4502 which is preferablyformed of first and second joined housing subassemblies 4504 and 4506.

The housing 4502 preferably comprises a plurality of mutuallyarticulated portions 4508, 4510 and 4512, which are preferably joined byflexible couplings 4514 and 4516. It may thus be appreciated that eachof housing subassemblies 4504 and 4506 preferably includes three housingsub-portions, designated respectively as 4518, 4520 and 4522 for housingsubassembly 4504 and 4528, 4530 and 4532 for housing subassembly 4506.

Housing portion 4508 is preferably the forward facing housing portionand includes a forward coil driving assembly 4540 mounted on housingsub-portion 4518 comprising an electric motor 4542, which is controlledby multi-functional controller 253 (FIG. 7) and which drives a roller4544, forming part of a three-roller pinch roller assembly 4546 whichalso includes rollers 4548 and 4550.

Rollers 4544, 4548 and 4550 are preferably configured to havecross-sections which correspond to the cross-sectional configurations ofthe lead portion 2734 (FIG. 73E) the engagement portion 2735 thereof,the connector 3060 and the main portion 3306 of the particular coil 3050which is employed.

Rearwardly of forward coil driving assembly 4540 there is preferablyprovided a coil feeder 4553 which feeds a coil 3050 into drivingengagement with forward coil driving assembly 4540. Coil 3050 may be anysuitable leadless coil, such as those described hereinabove withreference to FIGS. 76A-78L.

Located on a front face 4570 of housing portion 4508 and mountedrespectively on a front face 4572 of housing sub-portion 4528 and on afront face 4574 of housing sub portion 4528 are two quick connectionmounting assemblies, respectively designated by reference numerals 4576and 4578, which are ble for mounting of hands 900, of the type describedabove with reference to FIG. 27.

Front face 4570 is preferably formed with a coil outlet aperture 4580,which is defined by the respective front faces 4572 and 4574 of housingsub-portions 4518 and 4528. Coil outlet 4580 preferably has aconfiguration which corresponds to the maximum cross-sectionaldimensions of the lead portion 2734 (73E), the engagement portion 2735thereof, the connector 3060 and the main portion 3062 of the particularcoil 3050 which is employed.

Housing sub-portion 4528 is preferably formed with a vehicle dock 4582for removable docking thereto of a surgical vehicle, preferably vehicle800 (FIGS. 25A & 25B).

Front face 4570 is preferably formed with a lead inlet aperture 4584,which is defined by the respective front fines 457 and 4574 of housingsub-portions 4518 and 4528. Lead inlet aperture 4584 preferably has aconfiguration which corresponds to the maximum cross-sectionaldimensions of the lead portion 2734 (FIG. 73E) and the engagementportion 2735 thereof of the particular coil 3050 which is employed.

Intermediate housing portion 4510, disposed rearwardly of forward facinghousing portion 4508 and flexibly coupled thereto by means of flexiblecoupling 4514, preferably includes an intermediate coil driving assembly4590 mounted on housing sub-portion 4520. Assembly 4590 may be identicalin all relevant respects to assembly 4540 and its component areidentified by identical reference numerals.

Rearwardly of intermediate coil driving assembly 4590 there ispreferably provided a coil feeder 4592, which may be identical to feeder4553 and which feeds coil 3050 into driving engagement with intermediatecoil driving assembly 4590.

Housing sub-portion 4530, which forms part of intermediate housingportion 4510, is preferably formed with a vehicle dock 4594 forremovable docking thereto of a surgical vehicle, preferably vehicle 800(FIGS. 25A & 25B). Dock 4594 may be identical in all relevant respectsdock 4582.

Rearward housing portion 4512, disposed rearwardly of intermediatehousing portion 4510 and flexibly coupled thereto by means of flexiblecoupling 4516, includes rearward housing sub-portions 4522 and 4532which together preferably define a coil storage bay 4596 for storage ofcoil 3050 in a coiled orientation therein.

Also located in rearward housing portion 4512 is a winch 4597, typicallycomprising an electric motor 4598, controlled by multi-functionalcontroller 253 (FIG. 7) and a capstan 4599, driven by motor 4598. Winch4597 is operative to pull a cable 4600, having a connector 4601 at anouter facing end thereof, via a plurality of fairleads 4602. Connector4601 is adapted to be connected to engagement socket 2735 of coiled lead2734 (FIG. 73E).

It is appreciated that the overall configuration of the flat discreplacement coil transporter and dispenser 4500 is such that it does notfill of the space in the third cannula subassembly and does not engageall of the tracks. In a preferred embodiment of the present invention,sufficient room is left free inside the outer portion 500 of the thirdcannula subassembly to enable operation of a surgical vehicle 800,supported on a track 504 (FIG. 22), alongside the flat disc replacementcoil transporter and dispenser 4500.

Preferably, the flat disc replacement coil transporter and dispenser4500 also defines longitudinal recesses 4608, 4610, 4612, 4614, 4616 &4618 for mounting engagement with respective tracks 504, 508, 504, 506,504 & 506 of the outer portion 500 of the third cannula subassembly asseen in FIG. 22.

It is noted that flat disc replacement coil transporter and dispenser4000 may be notified also to include a winch operative to pull a cable,having a connector at an outer facing end thereof, via a plurality offairleads. Such connector may be adapted to be connected to the head2759 of lead 2760 (FIG. 76A) or of any other suitable non-leadless flatdisc replacement coil transporter and dispenser, thus obviating the needfor pulling the lead 2760 by means of an auxiliary surgical vehicle 800,as described hereinabove with reference to FIGS. 88A and 88B.

Reference is now made to FIGS. 92A & 92B, which are pictorialillustrations of two different tools useful in association with the flatdisc replacement coil transporter and dispenser 4500 of FIG. 91. Thetools of FIGS. 92A & 92B preferably mounted onto hands, such as the handshown in FIG. 27, typically mounted ont one or more of quick connectionmounting assemblies 4576 and 4578 on the front ice 4570 of the flat discreplacement coil transporter and dispenser 4500 (FIG. 91) and/or onto asurgical vehicle, such as vehicle 800.

FIG. 92A illustrates a coil orienting tool, her designated by referencenumeral 4700 which may be employed in association with hand 900 andremovably and replaceably coupled to tool engagement element 930 thereof(FIG. 27). Tool 4700 typically comprises a multiply bent needle 4702which defines a hook portion 4704 at an extreme end thereof.

FIG. 92B illustrates a pair of pick and place tools 4710, which may beemployed in association with a par of universal hands 90D and removablyand replaceably coupled to respective tool engagement elements 930thereof (FIG. 27).

In accordance with one preferred embodiment of the present invention,each pick and place tool is a rigid element. Both left and rightengagement elements may be provided. An inner facing channel 4714 may beprovided on a concave surface 4726 of each tool in a predetermined whichmatches cross-sectional configuration of coiled lead 2734 of inflatableimplant 2490 (FIG. 75B) for placement of the implant 2490 in recess 2402(FIG. 69A), without disturbing the a arrangement of the coils of coiledlead 2734.

Reference is now made to FIGS. 93A & 93B, 94A & 94B which illustrateinsertion and inflation of another embodiment of inflatable implantbetween facing end plates of adjacent vertebrate. As seen in FIGS. 93A,93B, 94A & 94B, an inflatable implant 4750, which may be identical tothe implant described hereinabove with reference to FIG. 75B, isinserted preferably using a plurality of surgical vehicles 800 (FIGS.25A & 25B), hands 900 (FIG. 7), a pair of pick and place tools 4710(FIG. 92B), an inflation tool 1350 (FIG. 29F) and a gauging tool 1360(FIG. 29G) according to the final real time starting operation plan asmodified interactively in real time by the operator using inputs interalia from one or more of sensors 532 associated with illuminators 533.

In accordance with a preferred embodiment of the preset inventiontraction may be applied to the vertebrate in a controlled at this stage,preferably by operation of electric motor 118 (FIG. 1) operated bycontroller 119 (FIG. 1).

Specifically, FIGS. 93A and 93B are simplified pictorial illustrationsof insertion of a second embodiment of inflatable implant 4750, whichmay be identical to inflatable implant 2490 (FIG. 75B), between facingend plates of adjacent vertebrae, and FIGS. 94A and 94B are sectionalillustrations taken along lines LXXXXIV-LXXXXIV in FIGS. 93A and 93B.

It is seen that following completion of end plate reconstruction andreinforcement to the extent required as well as suitable end platemachining, and hereinabove with reference to FIGS. 65A-72B, theinflatable implant 4750 is inserted between end plates 2024 and 2025 ofrespective adjacent vertebra 2004 and 2005 (FIG. 48) in recess 2402(FIG. 69A).

Insertion of the implant 4750 between end plates 2024 and 2025preferably employs a of pick and place tools 4710 (FIG. 92B), eachpreferably mounted on a surgical vehicle 800 (FIGS. 25A & 25B) via hand900 (FIG. 27), as well as an inflation tool 1350 (FIG. 29F), preferablymounted on a surgical vehicle 800 (FIGS. 25A & 25B) via 900 (FIG. 27).Following insertion of the implant 4750, the pick and place tools are nolonger required and may be removed.

Inflatable implant 4750, upon insertion thereof between end plates 2024and 2025 as shown in FIG. 94A, is somewhat deflated. Subsequentinflation of the implant 4750 by means of inflation tool 1350 causesexpansion of implant 4750 preferably to the configuration shown in FIGS.93B and 94B. Gauging tool 1360 is preferably employed, as shown in FIGS.93B and 94B, for measuring the extend of inflation of the implant 4750and/or the resulting separation between adjacent vertebrae.

Alternatively or additionally, marks 4770 may be placed on implant 4750and/or on adjacent vertebrae to enable the orientation thereof to besensed using one or more of sensors 532 which may be associated withilluminators 533 (FIG. 20).

The information derived from the gauging tool 1360 and/or from sensors532 may be advantageously supplied to computer 148 (FIG. 2) forconfirmation purposes and also for interactive modification of the finalreal time starting operation plan.

Reference is now made to FIGS. 95A and 95B, which are respectivepictorial and partially cut-away pictorial views illustrating a firststage in the insertion of a flat disc replacement coil, such as coil3050 (FIG. 76D)) in accordance with a second embodiment of the presentinvention. As seen in FIGS. 95A and 95B, the first stage of insertion ofcoil 3050 preferably employs the flat disc replacement coil transporterand dispenser 4500 (FIG. 91) having a pair of hands 900 mounted on quickconnection mounting assemblies 4076 and 4078 thereof.

Prior to the stage illustrated in FIGS. 95A and 95B, preferably whilethe flat disc replacement coil transporter and dispenser 4500 (FIG. 91)lies outside the outer portion 500 of the third cannula subassembly 176,connector 3060 of coil 3050 (FIG. 76D) and connector 4601 of cable 4600(FIG. 91) are manually connected to engagement sockets 2735 and 2736 ofcoiled lead 2734 (FIGS. 93A and 93B).

This manual connection is preferably out by a staging technician.Following the manual connection, the flat disc replacement and dispenser4500 (FIG. 91) is inserted into and proceeds through the third cannulaassembly to a location adjacent vertebrae 2004 and 2005, being driven bysurgical vehicles 800 docked thereto, while winch 4597 (FIG. 91) takesup the slack in coiled lead 2734.

As seen in FIG. 95A, during positioning of the flat disc replacementcoil transporter and dispenser 4500 (FIG. 91) adjacent vertebrae 2004and 2005, tool 4700, mounted via a hand 900 onto a surgical vehicle 800may be employed to engage coiled lead 2734 for maintaining a desiredorientation thereof. During this time, tool 4200, mounted via a hand 900onto flat disc replacement coil transporter and dispenser 4500 (FIG. 91)is operative to engage and thus direct the main coil portion 3062 ofcoil 3050 for proper desired coiling thereof about inflatable implant4290 (FIG. 93A, 93B, 94A & 94B).

As seen in FIG. 95B, as compared with the arrangement shown in FIG. 91,it is seen that at this first stage of insert, connector 4601 of cable4600 and engagement socket 2735 of coiled lead 2734 are drawn inwardlytowards winch 4597, while, a corresponding length of the main coilportion 3062 of coil 3050 is played out.

Reference is now made to FIGS. 96A and 96B, which are respectivepictorial and partially cut-away pictorial views illustrating a secondstage in the insertion of a flat disc replacement coil, such as coil3050 (FIG. 76D), in accordance with a second embodiment of the presentinvention. As seen in FIGS. 96A and 96B, the second stage of insertionof coil 3050 preferably employs the same equipment as that employed inthe first stage illustrated in FIGS. 95A and 95B for continued coilingof the main coil portion 3062 about inflatable implant 4290 as shown.

Preferably tool 4200 is gradually is gradually repositioned so as toguide the main coil portion 3062 for producing a desired coilconfiguration. At this stage, tool 4700 engages the lead coil portion2734 for in maintaining order of the coiled lead coil portion 2734 andproducing orderly coiling of the main coil portion 3062 about theinflatable implant at 4290.

As see in FIG. 96B, as compared with FIG. 95B, it is seen that the cable4600 has been further wound on capstan 4599 at this stage, thus drawingconnector 4601, engagement socket 2735 and coiled lead 2734 inwardlythrough fairleads 4602 (FIG. 73).

Additionally dispenser tool 1319 is preferably employed in order toprovide a flowable bonding material to the main coil portion 3062 as itis being coiled about inflatable implant 4290. Alternatively, tool 4220may be employed instead of tool 4200 in order to coat the main coilportion 3062 with the bonding material and thus possibly to obviate theneed for operation of dispenser 1319.

Reference is now made to FIGS. 97A and 97B, which are respectivepictorial and partially cut-away pictorial views illustrating a thirdand final stage in the insertion of a flat disc replacement coil, suchas coil 3050 (FIG. 76D) in accordance with a second embodiment of thepresent invention. As seen in FIGS. 97A and 97B, the third stage ofinsertion of coil 3050 preferably employs the same equipment as theemployed in the first two stages illustrated in FIG. 95A-96B forcompleting the coiling of the main coil portion 3062 about inflatableimplant 4290 as shown.

It is seen that the cable 4600 and the lead coil portion 2734 have beenwound on winch 4597 at this stage. Laser cutting tool 4260 (FIG. 81D) isnow mounted on hand 900, which is in turn mounted on sa vehicle 800 andis preferably employed for cutting tail portion 2766 from the coiledmain coil portion 3062, preferably at junction 2768. Laser cutting tool4260 may also be employed for cutting connector 3060 from main coilportion 3062.

Turing to FIG. 97B, it is seen that the tail portion 2766 remains in thetransporter and dispenser 4000 and is appropriately tensioned andpositioned thereby, the cable 4600 and most of the lead coil portion2734 being wound on 4597.

At this stage, additional bonding material may be added as appropriateand the inflatable implant 4290 may be slighted deflated as appropriateand at an appropriate time with reference inter alia to removal of thethird cannula a subassembly, hands and tools from the operation site.

Deflation of inflatable implant 4290 may be carried out similarly to thedeflation described hereinabove with reference to FIGS. 90A and 90B.

Reference is now made to FIGS. 98A, 98B, 98C, 98D, 98E, 98F, 98G, 98H,98I, 99J & 98K, which are sectional illustration of the plurality ofalternative flat disc replacement coil configuration of FIGS. 76A-76K,77A-77K and 78A-78K installed in situ between facing vertebrae 2004 and2005 in accordance with a preferred embodiment of the present invention.

FIG. 98A illustrates inflatable implant 2700 by flat dic replacementcoil 2750, in situ between end plates 2024 and 2025, wherein convexrounded cross-sectional surface 2802 and convex rounded cross-sectionalsurface 2770 are seated in peripheral channels 2408 of respective endplates 2024 and 2025.

FIG. 98B illustrates inflatable implant 2720 surrounded in lockingengagement by flat disc replacement coil 2850, in situ between endplates 2024 and 2025, wherein convex rounded cross-sectional surface2802 and convex rounded cross-sectional surface 2770 are seated inperipheral channels 2408 of respective end plates 2024 and 2025.

FIG. 98C illustrates inflatable implant 2730 surrounded in lockingengagement by flat disc replacement coil 2950, in situ between endplates 2024 and 2025, wherein convex rounded cross-sectional surface2802 and convex rounded cross-sectional surface 2770 are seated inperipheral channels 2408 of respective end plates 2024 and 2025.

FIG. 98D illustrates inflatable implant 2710 surrounded in guidedengagement by flat disc replacement coil 3050, in situ between endplates 2024 an 2025, wherein convex rounded cross-sectional surface 2802and convex rounded cross-sectional surface 2770 are seated in peripheralchannels 2408 of respective end plates 2024 and 2025.

FIG. 98E illustrates inflatable implant 2700 surrounded by flat discreplacement coil 3070, in situ between end plates 2024 and 2025, whereinundercut concave cross-sectional surfaces 3072 and 3074 face peripheralchannels 2678 of respective end plates 2024 and 202. A flowable polymer4800, such as flowable polyurethane commercially available from AdvancedBio-Surfaces, Inc. of Minnetonka, Minn., USA is preferably inserted tofill the interstices between adjacent coils at concave cross-sectionalsurfaces 3072 and 3074 and peripheral channels 2678.

FIG. 98F illustrates inflatable implant 2700 surrounded by flat discreplacement coil 3080, in situ between end plates 2024 and 2025, whereinconvex cross-sectional coil 3118 and 3098 lockingly seat in peripheralchannels 2678 of respective end plates 2024 and 2025.

FIG. 98G illustrates inflatable implant 2720 surrounded by flat discreplacement coil 3180, in situ between end plates 2024 and 2025. Rib2722 and lip 2721 engage hook-like portions 3196, 3200, 3206 and 3212 ofrespective coils 3187, 3188, 3189 and 3190.

FIG. 98H illustrates inflatable implant 2700 surrounded by flat discreplacement coil 3280, in situ between end plates 2024 and 2025.

FIG. 98I illustrates inflatable implant 2700 by flat disc replacementcoil 3380, in situ between end plates 2024 and 2025.

FIG. 98J illustrate inflatable implant 2700 surrounded by flat discreplacement coil 3480, in situ between end plates 2024 and 2025, withrespect protrusions 3504, 3512, 3520 seating in recesses 3500, 3508 and3516.

FIG. 98K illustrates inflatable implant 2700 surrounded by flat discreplacement coil 3580, in situ between end plates 2024 and 2025. Thecoil is held together by “VELCRO”® type engagement. Additional “VELCRO”®engagement elements may lie in peripheral recesses 2678 formed in theend plates and may be retained therein by means of a flowable polymer4800, such as flowable polyurethane commercially available from AdvancedBio-Surfaces, Inc. of Minnetonka, Minn., USA which may also be insertedto fill the interstices between adjacent coils.

Reference is now made to FIG. 99, which is a partially sectional,partially pictorial illustration of an inflatable implant, such asinflatable implant 2700 surrounded by a double coil installed in situbetween facing vertebrae 2004 and 2005. The double coil may have thetype of configuration shown in FIG. 76A, 77A and 78A or any othersuitable type of configuration, wherein protrusions in the coil seat incorresponding peripheral recesses in the end plates 2024 and 2025.

Reference is now made to FIGS. 100A, 100B, 100C, 100D & 100E and 101A,101B, 101C, 101D & 101E which illustrate five variations of aninflatable implant assembly constructed and operative in accordance withanother preferred embodiment of the present invention.

FIGS. 100A and 101A illustrate one preferred embodiment of a generally“oval-shaped” inflatable implant assembly, this embodiment beingdesignated by reference numeral 5000. It is appreciated that any othersuitable configuration of an inflatable implant assembly mayalternatively be employed. For example a circular or round inflatableimplant assembly may be employed, as described hereinbelow withreference to FIGS. 136A and 136B.

Inflatable implant assembly 5000 preferably comprises an inflatableimplant portion 5002, preferably formed of a mechanically suitable,biologically compatible elastomer such as polyurethane by conventionalblow molding techniques preferably having integrally formed therewith aninflation conduit 5004 having mounted therein a conventional inflationvalve 5006.

The oval-shaped configuration is preferred because it generallycorresponds to the cross-sectional configuration of the end plates 2024and 2025 of the vertebrate. For the purposes of ease of description, theouter surface inflatable implant portion 5002 is considered herein ashaving first and second slightly curved generally planar surfaces 5008and 5010 and first and second intermediate edge surfaces 5012 and 5014,it being understood that edge surfaces 5012 and 5014 are joined togetherso as to define a complete peripheral edge and are joined with surfaces5008 and 5010 in a generally seamless manner to define a smooth outersurface for the implant.

As seen particularly in FIG. 101A, the slightly curved generally planarsurfaces 5008 and 5010 intermediate edge surfaces 5012 and 5014 arecurved to correspond to the configuration of the recess 2402 formed ineach end plate for secure seating therein and optimized distribution ofpressure and forces thereon and shock absorbing.

Inflatable implant portion 5002 is preferably formed with a generallycircularly ring-shaped recess 5020 at surface 5008 thereof. Recess 5020is preferably formed with an inclined peripheral surface 5026.

Removably seated in recess 5020 there is preferably provided a seatelement 5030, which defines a generally circular inner recess 5032therein, which defines a bearing race and preferably retains therein aplurality of balls 5034, thus defining a bearing. Seat element 5030preferably defines an outer recess 5036 which corresponds to recess 5020of implant portion 5002, and an outer flange 5038 which preferably restsagainst surface 5026 of implant portion 5002.

A circular sprocket 5050 is rotatably seated in outer recess 5036 ofseat element 5030 in bearing relationship with balls 5034 in the bearingrace defined inner recess 5032. Sprocket 5050 includes an underlyingbearing race defining circular recess 5052 which corresponds to recess5032. Sprocket 5050 also defines an inner circular of outwardly facingteeth 5054, which is engaged by a suitably toothed drive belt 5056.Sprocket 5050 further defines an outer circular array of outwardlyfacing teeth 5058, each of which is formed with a transverse recess5070.

Outer circular array of outwardly facing teeth 5058 drivingly engages acorrespondingly configured upstanding disc replacement coil for windingthereof, as is described hereinbelow with reference to FIGS. 102A-114E.

Sprocket 5050 also includes an overlying bearing race defining circularrecess 5080 which defines a bearing race and preferably retains thereina plurality of balls 5082, thus defining a bearing.

Inflatable implant assembly 5000 preferably also comprises a slightlycurved generally planar, oval-shaped cover portion 5090, preferablyformed of a mechanically suitable, biologically compatible plastic ormetal such as polyurethane or titanium and preferably configured tocorrespond to the machined vertebra end plate configuration illustrated,for example, in FIGS. 69C and 70E wherein a semicircularly-shapedportion 5092 thereof corresponds to recess 2672 and a generallycylindrical extension portion 5094 thereof corresponds to channel 2671,for secure seating therein and optimized distribution of pressure andforces thereon and shock absorbing.

The outer surface of cover portion 5090 includes a slightly curvedgenerally planar 50969, first and second elongate edge surfaces 5097 and5098 and a curved edge surface 5099, it being understood that edgesurfaces 5097, 5098 and 5099 are joined together so as to define acontinuous peripheral edge surface and are joined with surface 5096 in agenerally seamless manner to define a smooth outer surface the implantassembly 5000.

Cover portion 5090 is preferably formed with a generally circularlyring-shaped bearing race defining recess 5100 at an inner facing 5102.Recess 5100 corresponds to recess 5080 of sprocket 5050.

Optionally, the inflatable implant assembly 5000 may also include a basemember 5150 which underlies inflatable implant portion 5002. Base member5150 is preferably formed of a mechanically suitable, biologicallycorresponds to the machined as polyurethane of titanium and preferablyconfigured to correspond to the machined vertebra end plateconfiguration illustrated, for example, in FIGS. 69C and 70E wherein asemicircularly-shaped surface portion 5192 thereof to recess 2672 and agenerally cylindrical extension portion 5194 thereof corresponds tochannel 2671, for secure seating therein and optimize distribution ofpressure and forces thereon and shock absorbing.

It is appreciated that in accordance with an alternative embodiment ofthe present invention, one or both of cover member 5090 and base member5150 may be eliminated by machining and/or reconstruction of thevertebra end plates to correspond to the internally facing surfaces ofcover member 5090 and base member 5150.

FIGS. 100B and 101B illustrate another preferred embodiment of agenerally “oval-shaped” inflatable implant assembly, this embodimentbeing designated by reference numeral 5200. The implant assembly 5200may be identical to implant assembly 5000, described hereinbelow withreference to FIGS. 100A and 100A, identical elements being designated byidentical reference numerals, with the addition of first and secondgenerally oval ring-shaped recesses 5222 and 5224 at surface 5010thereof.

FIGS. 100C and 101C illustrate yet another preferred embodiment of agenerally “oval-shaped” inflatable implant assembly, this embodimentbeing designated by reference numeral 5300. The implant assembly 5300may be identical to implant assembly 5000, described hereinabove withreference to FIGS. 100A and 101A, identical elements being designated byidentical reference numerals, with the addition of the followingfeatures:

A rigid peripheral band 5302 is preferably formed at peripheral surfaces5012 and 5014 of inflatable implant portion 5002 and is secured in aperipheral recess 5304 formed thereat. Peripheral band 5302 ispreferably formed of a suitable composite material or a metal, such astitanium, and includes a bearing race defining, outer recess 5306.

Additionally or alternatively seat element 5030 having a bearing race5032 and balls 5034 may be replaced by a seat element 5330 having acircular array of bearing roller retaining recesses 5332 andcorresponding cylindrical bearing roles 5334 which are disposed on aninner surface 5335 of a outer recess 5336. Additionally a central recess5340 is located interiorly of the circular array of bearing rollerretaining recesses 5332.

Finally, sprocket 5050, having an inner array of outwardly facing teeth5054 and cooperating drive belt 5056 in implant assembly 5000 ispreferably replaced by a sprocket 5350 having a motor 5352 whichprovides rotation of outwardly facing teeth 5358, each of which isformed with a transverse recess 53700, relative to seat element 5330.Motor 5352 may be any suitable motor, such as an electric motor, apressurized fluid driven motor or a spring motor.

FIGS. 100D and 101D illustrate still preferred embodiment of a generally“oval-shaped” inflatable implant assembly, this embodiment beingdesigned by reference numeral 5400. The implant assembly 5400 may beidentical to implant assembly 5300, described hereinabove with referenceto FIGS. 100C and 101C, identical elements being designated by identicalreference numerals, with the addition of the following feature:

Peripheral band 5302, which includes a bearing race defining, outerfacing recess 5306 is preferably replaced by a peripheral 5402, formedof a suitable composite material or a metal, such as titanium, and whichincludes a peripheral array of recesses 5406 in which are disposedcylindrical bearing rollers 5408.

FIGS. 100E and 101E illustrate yet a further preferred embodiment of agenerally “oval-shaped” inflatable implant assembly, this embodimentbeing designated by reference numeral 5500. The implant assembly 5500may be identical to implant assembly 5300, described hereinabove withreference to FIGS. 100C and 101C, identical elements being designated byidentical reference numerals, with the addition of the followingfeature:

Peripheral band 5302 is eliminated and base member 5150 is replaced by abase member 5550 which has formed on an outer facing peripheral 5552thereof a bearing race defining, outer facing recess 5554.

Reference is now made to FIGS. 102A, 102B, 102C, 102D, 102E, 102F, 102G,102H, 102I, 102J & 102K; FIGS. 103A, 103B, 103C, 103D, 103E, 103F, 103G,103H, 103I, 103J & 103K and FIGS. 104A, 104B, 104C, 104D, 104E, 104F,104G, 104H, 104I, 104J & 104K, which are simplified illustrations of sixvariations of an upstanding disc replacement coil constructed andoperative in accordance with a first preferred embodiment of the presentinvention. The upstanding disc replacement coil is preferably formed ofa mechanically suitable, biologically compatible elastomer such aspolyurethane.

Referring now to FIGS. 102A, 103A and 104A, there is seen an upstandingdisc replacement coil 5600 which is suitable for use with inflatableimplant assembly 5000 described hereinabove with reference to FIGS. 100Aand 101A. Upstanding disc replacement coil 5600 typically comprises asprocket engagement belt 5602 having inwardly facing teeth 5604 arrangedfor operative engagement with the outer circular array of outwardlyfacing teeth 5058 of sprocket 5050. Belt 5602 is intended to beassembled over sprocket 5050 and retained thereon by means of an innerfacing peripheral protrusion 5606 which engages transverse recess 5070formed in teeth 5058 of sprocket 5050 (FIG. 100A).

Extending from engagement belt 5602, and preferably integrally formedtherewith is an upstanding coil winding portion 5610, which is formedwith an extra thick portion 5611 which, when wound about implant portion5002 (FIG. 100A), seats under engagement belt 5602. Coil winding portion5610 preferably but not necessarily is formed with a fiber reinforcinglayer 5612 and/or a compression wire 5613 formed of a suitable plasticor metal material. Coil winding portion 5610 preferably terminates in atail portion 5614 which is readily separable therefrom by a perforation5615.

Upstanding disc replacement coil 5600 is preferably formed of amechanically suitable, biologically compatible elastomer such aspolyurethane. It is appreciated that along the upstanding coil windingportion, the thickness of the portion and the type of reinforcementprovided thereto may vary, as may the material composition and othercharacteristic thereof. Furthermore, the width of the upstanding coilwinding portion may vary therealong such that the thickness of theupstanding coil when wound at various locations thereat corresponds tothe desired configuration of the resulting replacement disc.

Additionally or alternatively, the mechanical properties of the coilwinding portion 5610 may vary therealong. This may be achieved byforming voids or recesses 5618 at various locations in the coil windingportion, to reduce the rigidity and/or to increase the bendability ofthe coil winding portion thereat.

It is appreciated that the width of engagement belt 5602 is preferablyless than that of most of upstanding coil winding portion 5610, in orderto enable the engagement belt to be readily easily inserted between thevertebrae when slipped over sprocket 5050 when the inflatable implant5002 is not yet fully inflated; while the upstanding coil windingportion 5610 is of a width suitable for providing desired separationbetween adjacent vertebrae following further inflation of the inflatableimplant portion 5002.

Upstanding disc replacement coil 5600 is normally wound about inflatableimplant portion 5002 by rotation of sprocket 50550 in a clockwisedirection in the sense of FIGS. 100A and 102A. This causes theupstanding coil winding portion 5610 to be tightly wound about theengagement belt 5602 and thus about the inflatable implant portion 5002.

Preferably, the coil winding portion 5610 may be retained in a desiredwound arrangement by means of engagement between one or more suitablydisposed protrusions 5616 and corresponding sockets 5617 disposedadjacent the outer end of coil winding portion 5610.

The coil winding portion 5610 may advantageously be provided with aseries of apertures or outwardly facing sockets 5618 which may beengaged by an auxiliary coiling tool which is described hereinbelow withreference to FIG. 106A to assist in winding the coil winding portionabout the inflatable implant portion 5002. Compression wire 5613 mayalso be useful in this functionality.

Referring now to FIGS. 102B, 103B and 104B, there is seen an upstandingdisc replacement coil 5700 which is suitable for use with inflatableimplant assembly 5200 described hereinabove with reference to FIGS. 100Band 101B, inflatable implant assembly 5300 described hereinabove withreference to FIGS. 100C and 101C or inflatable implant assembly 5500described hereinabove with reference to FIGS. 100E and 101E.

Upstanding disc replacement coil 5700 typically comprises a sprocketengagement belt 5702 having inwardly facing teeth 5704 arranged foroperative engagement with the outer circular array of outwardly facingteeth 5058 of sprocket 5050 or teeth 5358 of sprocket 5350. Belt 5702 isintended to be assembled over sprocket 5050 or sprocket 5350 andobtained thereon by means of a inner facing peripheral protrusion 5706which engages transverse recess 5070 formed in teeth 5058 of sprocket5050 or transverse recess 5370 formed in teeth 5358 of sprocket 5350.

Extending from engagement belt 5702, and preferably integrally formedtherewith, is an upstanding coil winding 5710, which preferably but notnecessarily is formed with a fiber reinforcing layer. Coil windingportion 5710 preferably terminates in a tail portion 5714 which isreadily separable therefrom by a perforation 5716.

Upstanding disc replacement coil 5700 preferably includes a bearing racedefining protrusion or recess 5720 retaining bearing balls 5722 therein.The bearing race defining protrusion or recess 5720 is preferablylocated on a portion of the coil winding portion 5710 adjacentengagement belt 5702 and positioned so that upon willing thereof aboutengagement belt 5702, bearing balls 5722 engage a bearing rice definedand suitably positioned by recess 5224 upon suitable inflation ofinflatable implant portion 5002. Normally the length of the bearing racedefining protrusion recess 5720 corresponds to the outer circumferenceof the engagement belt 5702.

Upstanding disc replacement coil 5700 is preferably formed of amechanically suitable, biologically compatible elastomer such aspolyurethane. It is appreciated that along the upstanding coil windingportion, the thickness of the portion and the type of reinforcementprovided thereto only may vary, as may the material comparison and othercharacteristic thereof. Furthermore, the width of the upstanding coilwinding portion may vary therealong such that the thickness of theupstanding coil when wound at various locations thereat corresponds tothe desired configuration of the resulting replacement disc.

It is appreciated that the width of engagement belt 5702 is preferablyless than at of most of upstanding coil winding portion 5710, in orderto enable the engagement belt to be readily easily inserted between thevertebrae when assembled over sprocket 5050 or sprocket 5350 when theinflatable implant portion 5002 is not yet fully inflated; while theupstanding coil winding portion 5710 is of a width suitable forproviding desired separation between adjacent vertebrae followingfurther inflation of the inflatable implant portion 5002.

Referring now to FIGS. 102C, 103C and 104C, there is sew an upstandingdisc replacement coil 5800 which is suitable for use with inflatableimplant assembly 5400 described hereinabove with reference to FIGS. 100Dand 101D. Upstanding disc replacement coil 5800 typically comprises asprocket engagement belt 5802 having inwardly facing teeth 5804 arrangedfor operative engagement with the outer circular array of outwardlyfacing teeth 5358 of sprocket 5050. Belt 5802 is intended to beassembled over sprocket 5350 and retained thereon by means of an innerfacing peripheral protrusion 5806 which engages transverse recess 5370formed in teeth 5358 of sprocket 5350.

Extending from engagement belt 5802, and preferably integrally formedtherewith, is an upstanding coil winding portion 5810, which preferablybut not necessarily is formed with a fiber reinforcing layer. Coilwinding portion 5810 preferably terminates in a tail portion 5814 whichis readily separable therefrom by a perforation 5816.

Upstanding disc replacement coil 5800 preferably includes a bearing racedefining protrusion or recess 5820 which is suitable for engagingbearing rollers 5804 in the bearing race defined by peripheral band 5402in inflatable implant assembly 5400. The bearing race definingprotrusion or recess 5820 is preferably located on a portion of the coilwinding portion 5810 adjacent engagement belt 5802 and positioned sothat upon winding thereof about engagement belt 5802, bearing rolls 5804engage bearing race defining protrusion or recess 5820. Normally thelength of the bearing race defining protrusion or recess 5820corresponds to the outer circumference of the engagement belt 5602.

Upstanding disc replacement coil 5800 is preferably formed of amechanically suitable, biologically compatible elastomer such aspolyurethane. It is appreciated that along the upstanding coil windingportion, the thickness of the portion and the type of reinforcementprovided thereto may vary, as may the material position and othercharacteristics thereof.

Furthermore, the width of the upstanding coil winding portion may varytherealong such that the thickness of the upstanding coil when wound atvarious locations thereat corresponds to the desired configuration ofthe resulting replacement disc.

It is appreciated that the width of engagement belt 5802 is preferablyless than that of most of upstanding coil winding portion 5810, in orderto enable the engagement belt to be readily easily inserted between thevertebrae when assembled over sprocket 5350 when the inflatable implantportion 5002 is not yet fully inflated; while the upstanding coilwinding portion 5810 is of a width suitable for providing desiredseparation between adjacent vertebrae following further inflation of theinflatable implant portion 5002.

Referring now to FIGS. 102D, 103D and 104D, there is seen an upstandingdisc replacement coil 5900 which is suitable for use with inflatableimplant assembly 5000 described hereinabove with reference to FIGS. 100Aand 101A. Upstanding disc replacement coil 5900 typically comprises asprocket engagement belt 5902 having inwardly facing teeth 5904 arrangedfor operative engagement with the outer circular array of outwardlyfacing 5058 of sprocket 5050. Belt 5902 is intended to be assembled oversprocket 5050 and retained thereon by means of an inner facingperipheral protrusion 5906 winch engages transverse recess 5070 formedin teeth 5058 of sprocket 5050.

Extending from engagement belt 5902, and preferably integrally formedtherewith, is an upstanding coil winding portion 5910, which is formedwith a non flat cross-section along at least a portion 5912 of itslength. Coil winding portion 5910 preferably terminates in a tailportion 5914 which is readily separable therefrom by a perforation 5916.

The provision of a non-flat cross-section provides enhanced rigidity tothe coil winding portion 5912 when in an elongate orientation under theapplication of linear compressive forces thereto, as during windingthereof with assistance of an external pushing tool, as describedhereinbelow with reference to FIG. 105.

Upstanding disc replacement coil 5900 is preferably formed of amechanically suitable, biologically compatible elastomer such aspolyurethane. It is appreciated that along the upstanding coil windingportion, the thickness of the portion and the type of reinforcementprovided thereto may vary, as may the material composition and othercharacteristics thereof. Furthermore, the width of upstanding coilwinding portion may vary therealong such that the thickness of theupstanding coil when wound at various locations thereat corresponds tothe desired configuration of the resulting replacement disc.

Upstanding disc replacement coil 5900 is normally wound about inflatableimplant portion 5002 by rotation of sprocket 5050 in a clockwisedirection in the sense of FIGS. 100A and 100A. This the upstanding coilwinding portion 5610 to be tightly wound about the engagement belt 5902and thus about the inflatable implant portion 5002. It is appreciatedthat the non-flat cross-section of portion 5912 maintains a desiredseparation between wound layers of portion 5912 when the are tightlywound, enabling relative ease of engagement therewith.

Referring now to FIGS. 102E, 103E and 104E, there is seen an upstandingdisc replacement coil 6000 which is suitable for use with inflatableimplant assembly 5000 described hereinabove with reference to FIGS. 100Aand 101A. Upstanding disc replacement coil 6000 typically comprises asprocket engagement belt 6002 having inwardly facing teeth 6004 arrangedfor operative engagement with the outer circular array of outwardlyfacing teeth 5058 of sprocket 5050. Belt 6002 is intended to beassembled over sprocket 5050 and retained thereon by means of an innerfacing peripheral protrusion 6006 which engages transverse recess 5070formed in teeth 5058 of sprocket 5050.

Extending from engagement belt 6002, and preferably integrally formedtherewith, is an upstanding coil winding portion 6010, which preferablyterminates in a tail portion 6013 which is readily separable therefromby a perforation 6016.

Upstanding coil winding portion 6010 is preferably formed with anon-flat cross-section along at least a portion 6012 of its length. Thenon-flat cross-section of portion 6012 preferably defines at least oneand preferably a pair of elongate recesses 6014 on a first surface 6016of portion 6012 and at least one aid preferably a pair of terminatingelongate recesses 6018 on a second surface 6019 of portion 6012.

The relative locations of the first and second surfaces 6016 and 6019are preferably selected such that when the coil winding portion 6010 istightly wound about the inflatable implant portion 5002, recesses 6014and 6018 face each other and together define an enclosed space suitablefor insertion thereinto of a flowable elastomer.

Upstanding disc replacement coil 6000 is preferably formed of amechanically suitable, biologically compatible elastomer such aspolyurethane. It is appreciated that along the upstanding coil windingportion, the thickness of the portion and the type of reinforcementprovided thereto may vary, as may the material composition and othercharacteristics thereof. Furthermore, the width of the upstanding coilwinding portion may very therealong such that the thickness of theupstanding coil when wound at various locations thereat correspond tothe desired configuration of the resulting replacement disc.

Referring not to FIGS. 102F, 103F and 104F, there is seen an upstandingdisc replacement coil 6100 which is suitable for use with inflatableimplant assembly 5000 described hereinbelow with reference to FIGS. 100Aand 101A. Upstanding disc replacement coil 6100 typically comprises asprocket engagement belt 6102 having inwardly facing teeth 6104 arrangedfor operative engagement with the outer circular array of outwardlyfacing teeth 5058 of sprocket 5050. Belt 6102 is intended to beassembled over sprocket 5050 and retained thereon by means of an innerfacing peripheral protrusion 6106 which engages transverse recess 5070formed in teeth 5058 of sprocket 5050.

Extending from engagement belt 6102, and preferably integrally formedtherewith is an upstanding coil winding portion 6110, which preferablyterminates in a tail portion 6114 which is readily separable therefromby a perforation 6116.

Upstanding coil winding portion 6110 is preferably formed at a portion6118 thereof with a non-flat cross-section along at least one of the topand bottom edges 6120 and 6122 thereof.

These edges are configured to at least partially lockingly engage withone or more of peripheral recesses 2678 (FIG. 71B), 2684 (FIG. 72B) and2686 (FIG. 72B) formed by suitable machining of end plates 2024 and 2025of vertebrae 2004 and 2005. Preferably the peripheral recesses areformed with an undercut configuration and the cross-sections of at leastone of the top and bottom edges 6120 and 6122 are correspondinglyconfigured.

In the embodiment of FIGS. 102F, 103F and 104F, a single coil of portion6118 is intended to be retained in a peripheral recess.

Referring now to FIGS. 102G, 103G and 104G, there is seen an upstandingdisc replacement coil 6200 which is suitable for use with inflatableimplant assembly 5000 described hereinabove with reference to FIGS. 100Aand 101A. Upstanding disc replacement coil 6200 typically comprises asprocket engagement belt 6202 having inwardly facing teeth 6204 arrangedfor operative engagement with the outer circular array of outwardlyfacing teeth 5058 of sprocket 5050. Belt 6202 is intended to beassembled over sprocket 5050 and retained thereon by means of an innerfacing peripheral protrusion 6206 which engages transverse recess 5070formed in teeth 5058 of sprocket 5050.

Extending from engagement belt 6202, and preferably integrally formedtherewith, is an upstanding coil winding portion 6210, which preferablyterminates in a tail portion 6214 which is readily separable therefromby a perforation 6216.

Upstanding coil winding portion 6210 is preferably formed at a portion6218 thereof with a non-flat cross-section along at least one of the topand bottom edges 6220 and 6222 thereof. These edges are configured to atleast partially lockingly engage with one or more of peripheral recesses2678 (FIG. 71B), 2684 (FIG. 72B) and 2686 (FIG. 72B) formed by suitablemachining of end plates 2024 and 2025 of vertebrae 2004 and 2005.

Preferably the peripheral recesses are formed with an undercutconfiguration and the cross-sections of at least one of the top andbottom edges 6220 and 6222 are correspondingly configured, such thatedges of a pair of adjacent coils at least partially engage a peripheralrecess.

In the embodiment of FIGS. 102G, 103G and 104G, at least one of edges6220 and 6222 preferably defines at least one and preferably a pair ofelongate protrusions 6214 on a first surface 6216 of portion 6212 and atleast one and preferably a pair of matching elongate protrusions 6218 ona second surface 6219 of portion 6212.

The relative location of the first and second surfaces 6216 and 6219 arepreferably selected such that when the coil winding portion 6210 istightly wound about the inflatable implant portion, 5002, protrusions6214 and 6218 face oppositely to each other and together define a doubleprotrusion suitable for at least partially locking engagement in aperipheral recess.

Reference is now made to FIG. 105, which is a pictorial illustration inexploded view format of an upstanding disc replacement coil transporterdispenser 6300 constructed and operative in accordance with a preferredembodiment of the present invention. The upstanding disc replacementcoil transporter and dispenser 6300 preferably includes a housing 6302which is preferably formed of first and second joined housing portions6304 and 6306.

The housing 6302 preferably comprises a plurality of mutuallyarticulated portions 6308, 6310 and 6312, which are preferably joined byflexible couplings 6314 and 6316. It may thus be appreciated that eachof housing portions 6304 and 6306 preferably includes three housingsub-portions, designated respectively as 6318, 6320 and 6322 for housingportion 6304 and 6328, 6330 and 6332 for housing portion 6306.

Housing portion 6308 is preferably the forward facing housing portionand includes a forward coil driving assembly 6340 mounted on housingsub-portion 6318 and includes an electric motor 6342, which iscontrolled by multi-functional controller 253 (FIG. 7) and which drivesa roller 6344, forming part of a three-roller pinch roller assembly 6346which also includes rollers 6348 and 6350.

As in the embodiment shown in FIGS. 79 and 80A, it is appreciated thatrollers 6344, 6348 and 6350 are preferably configured to havecross-sections which correspond to the cross-sectional configurations ofthe various portions of the particular coil which is employed.

Rearwardly of forward coil driving assembly 6340 there is preferablyprovided a coil feeder 6353 which feeds a coil 6360 into drivingengagement with forward coil driving assembly 6340. Coil 6360 may be anysuitable coil, such as those described hereinabove with reference toFIGS. 102A-102G, 103A-103G and 104A-104G.

As in the embodiment of FIGS. 79 and 80B, feeder 6353 has the generalconfiguration of a funnel.

Located on a front face 6370 of housing portion 6308 and mounted on afront face 6372 of housing sub-portion 6318 and on a front face 6374 ofhousing sub-portion 6328 are quick connection mounting assemblies,respectively designated by reference numerals 6376 and 6378, which aresuitable for mounting of hands, of the type described above withreference to FIG. 27.

Front face 6370 is preferably form with a coil outlet and driving beltaccommodating aperture 6380, which is defined by the respective frontfaces 6372 and 6374 of housing sub-portions 6318 and 6328. Coil outletand driving belt accommodating aperture 6380 preferably has aconfiguration which is larger than the maximum cross-sectionaldimensions of the particular coil that is being employed and issufficiently large to accommodate driving belt 5056 (FIG. 100A).

Housing sub-portion 6328 is preferably formed with a vehicle dock 6382for removable docking thereto of a surgical vehicle, preferably vehicle800 (FIGS. 25A & 25B).

Intermediate housing portion 6310, disposed rearwardly of forward facinghousing portion 6308 and flexibly coupled thereto by means of flexiblecoupling 6314, preferably includes an intermediate coil driving assembly6390 mounted on housing sub-portion 6320. Assembly 6390 may be identicalin all relevant respects to assembly 6340 and its components areidentified by identical reference numerals.

Rearwardly of intermediate coil driving assembly 6390 there ispreferably provided a coil feeder 6392, which may be identical to feeder6353 and which feeds coil 6360 into driving engagement with intermediatecoil driving assembly 6390.

Housing sub-portion 6330, which forms part of intermediate housingportion 6310, is preferably formed with a vehicle dock 6394 forremovable docking thereto of a surgical vehicle, preferably vehicle 800(FIGS. 25A & 25B). Dock 6394 may be identical in all relevant respectsto dock 6382.

Rearward housing portion 6312, disposed rearwardly of intermediatehousing portion 6310 and flexibly coupled thereto by means of flexiblecoupling 6316, includes rearward housing sub-portions 6322 and 6332which together preferably define a coil storage bay 6396 for storage ofcoil 6360 in a coiled orientation therein.

It is appreciated that the overall configuration of the upstanding discreplacement coil transporter and dispenser 6300 is such that it does notfill all of the space in the third cannula subassembly and does notengage all of the tracks. In a preferred embodiment of the presentinvention, sufficient room is left free inside the third cannulasubassembly to enable operation of a surgical vehicle 800, supported ona track 504 (FIG. 22), alongside the upstanding disc replacement coiltransporter and dispenser 6300.

Preferably, the upstanding disc replacement coil transporter anddispenser 6300 also defines longitudinal recesses 6398, 6400, 6402,6404, 6406 & 6408 for mounting engagement with respective tracks 504,508, 504, & 506 of the third cannula subassembly as seen in FIG. 22.

Driving belt 5066 is preferably driven by a sprocket drive assembly6507, typically comprising an electric motor 6708, controlled bymulti-functional controller 253 (FIG. 7) and a sprocket 6709, driven bymotor 6708. Sprocket drive assembly 6707 is operative to drive drivingbelt 5056, via a plurality of fairleads 6712.

Reference is now made to FIGS. 106A, 106B, 106C & 106D, which arepictorial illustrations of four different tools useful association withthe upstanding disc replacement coil transporter and dispenser of FIG.105.

FIG. 106A illustrates a coil winding assistance tool, here designated byreference numeral 6800, which may be employed in association withuniversal hand 900 and removably and replaceably coupled to toolengagement element 930 thereof (FIG. 27). Tool 6800 typically comprisesa base 6802 which is arranged to the coupled to tool engagement element930 of hand 900 (FIG. 27) and an arm 6804 extending outwardly from base6802 in a curved manner.

An outwardly extending finger 6806 and a transversely extending thumb6808 are provided at an end of arm 6804, opposite to the end of arm 6804which is attached to base 6802. Finger 6806 and thumb 6808 areconfigured to cooperate with socket 5618 on coil 5600 for assisting inthe winding thereof.

FIG. 106B illustrates an inflator tool 6818 which may be employed inassociation with universal hand 900 and removably and replaceablycoupled to tool engagement element 930 thereof (FIG. 27). Inflator tool6818 receives a pressurized fluid input via a flexible fluid supply the6820 from a pressurized source (not shown) typically located outside thepatient and provides a desired supply of fluid via an output nozzle6821.

It may be appreciated that inflator tool 6818 may be distinguished frominflator tool 1350 (FIG. 29F) in that inflator tool 6818 formed with agrooved portion 6822 which is configured so as to enable tool 6818 to bereadily grasped by forceps tool 4240 (FIG. 81C).

FIG. 106C illustrate a multi-functional coil orienting and coating &pick and place tool, here designated by reference numeral 6830, whichmay be employed in association with universal hand 900 and removably andreplaceably coupled to tool engagement element 930 thereof (FIG. 27).Tool 6830 typically comprises a base 6832, which is arranged to becoupled to tool engagement element 930 of hand 900 (FIG. 27), a bodyportion 6833 extending therefrom, and an arm 6834 extending outwardlyfrom body portion 6833 in a curved manner and having a rounded tip 6836.

Disposed on a back surface 6838 of arm 6834 there is preferably provideda spur element 6840, which is preferably configured to cooperate withsocket 5618 on coil 5600 for assisting in the winding thereof.

A coil coating passage 6850 is provided for supplying a liquid coatingmaterial to the coil 5600 as the coil passes therethrough. The liquidcoating material may be an in situ polymerizable polymer which, whenpolymerized, becomes a elastomeric bond substance. A preferred materialis a flowable polyurethane commercially available from AdvancedBio-Surfaces, Inc. of Minnetonka, Minn., USA. The structure of coilcoating passage 6850 and the supply of liquid coating material theretovia a liquid supply conduit 6852 may be similar to those describedhereinabove with reference to the embodiment of FIG. 81B.

FIG. 106D illustrates a coil bonding adhesive curing tool, heredesignated by reference numeral 6860, which may be employed associationwith universal hand 900 and removably and replaceably coupled to toolengagement element 930 thereof (FIG. 27). Tool 6860 typically comprise abase 6862 which is arranged to be coupled to tool engagement element 930of hand 900 (FIG. 27) and an arm 6864 extending outwardly from base 6862in a curved manner.

An ultraviolet light output device 6866 is preferably mounted on an endof arm 6864, opposite to the end of arm 6864 which is a to base 6862.Ultraviolet light output device 6866 preferably receives ultravioletlight from an external source (not shown) via an optical fiber 6868.

Reference is now made to FIGS. 107A and 107B, which are simplifiedpictorial illustrations of insertion and inflation of the inflatableimplant assembly of FIGS. 100A, 101A, 102A, 103A and 104A between facingend plates of adjacent vertebrae and to FIGS. 108A and 108B, which armsectional illustrations taken along lines CVIIIA-CVIIIA andCVIIIB-CVIIIB in FIGS. 107A and 107B.

It is seen that following completion of end plate reconstruction andreinforcement to the extent required, as well as suitable end platemachining, described hereinabove with reference to FIGS. 65A-72B, andspecifically with reference to FIG. 70E, the inflatable implant assembly5000, having the engagement belt 5602 of upstanding disc replacementcoil 5600 engaging teeth 5068 of sprocket 5050 and having the drivingbelt 5056 which is drivingly coupled to upstanding disc replacement coiltransporter and dispenser 6300 engaging teeth 5054 of sprocket 5050thereof, is inserted between end plates 2024 and 2025 of respectiveadjacent vertebra 2004 and 2005 (FIG. 48) in recess 2672 and channel2671 (FIG. 70E).

Insertion of the implant assembly 5000, having the engagement belt 5602of upstanding disc replacement coil 5600 engaged therewith, between endplates 2024 and 2025 preferably employs tools 1324 (FIG. 29E) and 6830(FIG. 106C). Tool 1324 is preferably mounted on a surgical vehicle 800(FIGS. 25A & 25B) via a hand 900 (FIG. 27).

Tool 6830 is preferably mounted on upstanding disc replacement coiltransporter and dispenser 6300 via a hand 900 (FIG. 27) and ispositioned between engagement belt 5602 and coil portion 5610. At thisstage, upstanding disc replacement coil transporter and dispenser 6300contains coil 5600 in an orientation ready for winding as well asdriving belt 5056 in an orientation ready for driving the sprocket 5050of implant assembly 5000.

Inflation tool 6818 (FIG. 106B) is premounted onto implant assembly 5000and is operatively coupled thereto via valve 5006 (FIG. 100A).

Inflatable implant portion 5002 of inflatable implant assembly 5000,upon insertion thereof between end plates 2024 and 2025 as shown inFIGS. 107A & 107B, is somewhat deflated. Subsequent inflation of theimplant portion 5002 by means of inflation tool 6818 causes expansion ofimplant portion 5002 preferably to the configuration shown in FIGS. 107Band 108B. Gauging tool 1360 (FIG. 29G) is preferably employed, as shownin FIGS. 107B and 108B, for measuring the extent of inflation of theimplant portion 5002 and/or the resulting separation between adjacentvertebra.

Alternatively or additionally marks 6870 may be placed on implantportion 5002 and/or on adjacent vertebra to enable the orientationthereof to be sensed using one or more of sensors 532 which may beassociated with illuminators 533 (FIG. 20).

The information derived from the gauging tool 1360 and/or from sensors532 may be advantageously supplied to computer 148 (FIG. 2) forconfirmation purposes and also for interactive modification of the finalreal time starting operation plan.

Reference is now made to FIGS. 109-112, which illustrate four stages inthe insertion of an upstanding disc replacement coil in accordance witha first embodiment of the present invention. FIG. 109 is a pictorialview illustrating a first stage in the insertion of an upstanding discreplacement coil in accordance with a first embodiment of the presentinvention.

As seen in FIG. 109, when the inflatable implant assembly 5000 islocated between adjacent vertebrae 2004 and 2005 and is suitablyinflated and when upstanding disc replacement coil transporter anddispenser 6300 (FIG. 105) is located adjacent vertebrae 2004 and 2005,tool 6830, mounted via a hand 900 onto upstanding disc replacement coiltransporter and dispenser 6300, may be employed to engage upstandingcoil winding portion 5610 of coil 5600. For this purpose, tool 6830 maybe positioned adjacent vertebra 2004 and 2005 rather than therebetweenas at the previous stage, shown in FIGS. 107A and 107B.

During this time, tool 6800, mounted via a second hand 900 onto a secondsurgical vehicle 800, is operative to assist in winding the coil windingportion 5610.

Additionally, dispenser tool 1319 is preferably employed in order toprovide a flowable bonding material to the coil winding portion 5610 asit is being coiled about inflatable implant portion 5002.

Thus it may be appreciated that motor 6708 (FIG. 105) drives drivingbelt 5056 in driving engagement with sprocket 5050, causing engagementbelt 5602 to wind the coil winding portion 5610 about engagement belt5602 and about the inflatable implant portion 5002. During this windingprocedure, the forward and rearward coil driving assemblies 6340 and6390 push the coil winding portion, this participating in the windingthereof.

It may be appreciated that coordination between the operation of motor6708 on the one hand, and coil driving assemblies 6340 and 6390 on theother hand, can govern the tightness of the wound coil. Control of thetightness of the wound coil at various stages in the winding thereof maybe important since the ease of winding the coil is affected by thetightness thereof ad since lubricants and bonding materials can bebetween relatively loosely wound portions of a wound coil.

Tool 6800 (FIG. 106A) may be employed as appropriate to push and/or pullthe coil winding portion 5610, in with sockets 5617, in order to alsoparticipate in governing the tightness of the wound coil.

FIG. 110 shows the upstanding disc replacement coil 5600 partially woundabout the inflatable implant portion 5002. FIG. 111 shows coil 5600tightly wound about inflatable implant portion 5002 and tensioned suchthat protrusions 5616 engage sockets 5617 for locking the discreplacement coil portion 5610 in tightly wound engagement with theinflatable implant portion 5002.

As sew in FIG. 111, laser coil cutting tool 4260 (FIG. 81D), mounted viaa hand 900 onto a surgical vehicle 800 in place of tool 6800, may beused to cut the upstanding disc replacement coil 5600 along perforation5615, thereby to detach tail 5614 from the coil winding portion 5610.

FIG. 112 shows bonding of the end 6880 of the coil winding portion 5610adjacent the location of perforation 5615 to the outer portion of thewound coil. This is preferably carried out by using tools 6830 (FIG.106) and 6860 (FIG. 106D). Edge 6836 of tool 6830 is employed to smooth,press and retain end 6880 against the outer portion of the wound coil,optionally after application thereto of a bonding material by means ofdispenser tool 1319, while tool 6860 is employed for UV curing of thebonding material applied to end 6880 either by means of tool 1319 and/orby means of passage 6850 of tool 6830.

Deflation of inflatable implant portion 5002 may be carried outsimilarly to the deflation described hereinabove with reference to FIGS.90A and 90B, as illustrated in FIG. 113. Following deflation, tool 6818may be detached from inflatable implant assembly 5000 by means offorceps tool 4240 (FIG. 81C), which engages portion 6822 of tool 6818(106B).

Reference is now made to FIGS. 114A & 114B and 115A & 115B, which aresimplified pictorial illustrations of two variations of an inflatableimplant constructed and operative in accordance with yet anotherpreferred embodiment of the present invention.

FIGS. 114A and 115A illustrate one preferred embodiment of a generally“bean shaped” inflatable implant 2480 (FIG. 53B), this embodiment beingdesignated by reference numeral 7000. Inflatable implant 7000 ispreferably formed of a mechanically suitable, biologically compatibleelastomer such as polyurethane by conventional blow molding techniquespreferably having integrally formed therewith a conventional inflationvalve 2701 located at a outward facing end of an elongate inflationconduit 7057.

Conduit 7057 preferably has a cross-sectional configuration which isadapted to fit the contours of channel 2610 (FIG. 69B). Conduit 7057preferably extends to the periphery of the end plates 2024 and 2025 andenables inflation and deflation of the inflatable implant 7000 from alocation outside of the end plates via valve 2701.

The bean shaped configuration is preferred because it generallycorresponds to the cross-sectional configuration of the end plates 2024and 2025 of the vertebra. For the purposes of ease of description, theouter surface of inflatable implant 7000 is considered herein as havingfirst and second slightly curved generally planar surfaces 7002 and 7004and first and second intermediate edge surfaces 7006 and 7008, it beingunderstood that edge surfaces 7006 and 7008 are joined together so as todefine a complete peripheral edge surfaces and are joined with surfaces7002 and 7004 in generally seamless manner to define a smooth outersurface for the implant.

As seen particularly in FIG. 114A, the slightly curved generally planarsurfaces 7002 and 7004 intermediate edge surfaces 7006 and 7008 arecurved to correspond to the configuration of the recess 2402 formed ineach end plate for secure seating therein and optimized distribution ofpressure and forces thereon and shock absorbing.

FIGS. 114B and 115B illustrate another preferred embodiment of agenerally “bean shaped” inflatable implant 2480 (FIG. 53B), thisembodiment designated by reference numeral 7010. Inflatable implant 7010may be generally similar to inflatable implant 7000 with the addition ofan outwardly extending rib 7012 having a keystone-shaped cross-section.Rib 7012 is preferably provided to assist in securing an upstanding discreplacement implant 7200 (FIG. 116B) in engagement with the inflatableimplant 7010 in certain embodiments of the invention as describedhereinbelow.

Reference is now made to FIGS. 116A & 116B, 117A & 117B and 118A & 118Bwhich illustrate two variations of an upstanding disc replacement coilconstructed and operative in accordance with another preferredembodiment of the present invention.

Referring now to FIGS. 116A, 117A and 118A, there is seen an upstandingdisc replacement coil 7100 which is suitable for use with inflatableimplant 7000 described hereinabove with reference to FIGS. 114A and115A. Upstanding disc replacement coil 7100 typically comprise a curvedforward portion 7102 followed by an upstanding coil winding portion7110, which preferably but not necessarily is formed with a fiberreinforcing layer 7112 and/or a compression wire 7113 formed of asuitable plastic or metal material. Coil winding portion 7110 preferablyterminates in a tail portion 7114 which is readily separable therefromby a perforation 7115.

Upstanding disc replacement coil 7100 is preferably formed of amechanically suitable, biologically compatible elastomer such aspolyurethane. It is appreciated that along the upstanding coil windingportion, the thickness the portion and the type of reinforcementprovided thereto may vary, as may the material composition and othercharacteristics thereof.

Furthermore, the width of the upstanding coil winding portion may varytherealong such that the thickness of the upstanding coil when wound atvarious locations thereat corresponds to the desired configuration ofthe resulting replacement disc.

Additionally or alternatively, the mechanical properties of the coilwinding portion 7110 may vary therealong. This may be achieved byforming voids or recesses 7118 at various locations in the coil windingportion, to reduce the rigidity and/or to increase the bendability ofthe coil winding portion thereat.

Upstanding disc replacement coil 7100 is normally wound about inflatableimplant 7000 in a clockwise direction in response to the application ofa compression force thereto. This causes the upstanding coil windingportion 7110 to be tightly wound about the inflatable implant 7000.

Preferably, the coil winding portion 7110 may be retained in a desiredwound arrangement by means of engagement between one or more suitablydisposed protrusions 7116 and corresponding sockets 7117 disposedadjacent the outer end of coil winding portion 7110.

The coil winding portion 7110 may advantageously be provided with aseries of apertures or outwardly facing sockets 7118 which may beengaged by an auxiliary coiling tool 6800 which is described hereinabovewith reference to FIG. 106A to assist in winding the coil windingportion about the inflatable implant 7000. Compression wire 7113 mayalso be useful in this functionality.

Referring now to FIGS. 116B, 117B and 118B, there is seen an upstandingdisc replacement coil 7200 which is suitable for use with inflatableimplant 7000 described hereinabove with reference to FIGS. 114B and115B. Upstanding disc replacement coil 7200 may be identical toupstanding disc replacement coil 7100 (FIGS. 116A, 117A & 118A) with theaddition of an outwardly extending rib 7212 having a keystone-shapedcross-section and a corresponding inwardly extending recess 7214 havinga correspondingly configured keystone-shaped cross-section for engagingrib 7012 of implant 7000 (FIG. 114) and rib 7212.

It is appreciated that the embodiments of FIGS. 116A, 116B, 117A, 117B,118A & 118B may also include one or more of the features describedhereinabove with reference to any of FIGS. 102E, 102F and 102G.

Reference is now made to FIG. 119, which is a pictorial illustration inexploded view format of an upstanding disc replacement coil transporterand dispenser 7300 constructed and operative in accordance with apreferred embodiment of the present invention.

The upstanding disc replacement coil transporter and dispenser 7300preferably includes a housing 7302 which is preferably formed of firstand second joined housing portions 7304 and 7306.

The housing 7302 preferably comprises a plurality of mutuallyarticulated portions 7308, 7310 and 7312, which are preferably joined byflexible couplings 7314 and 7316. It may thus be appreciated that eachof housing portions 7304 and 7306 preferably includes three housingsub-portions, designated respectively as 7318, 7320 and 7322 for housingportion 7304 and 7328, 7330 and 7332 for housing portion 7306.

Housing portion 7308 is preferably the forward facing housing portionand includes a forward coil driving assembly 7340 mounted on housingsub-portion 7318 and includes an electric motor 7342, which iscontrolled by multi-functional controller 253 (FIG. 7) and which drivesa roller 7344, forming part of a three-roller pinch roller assembly 7346which also includes rollers 7348 and 7350.

As in the embodiment shown in FIGS. 79 and 80A, it is appreciated thatrollers 7344, 7348 and 7350 are preferably configured to havecross-sections which correspond to the cross-sectional configurations ofthe various portions of the particular coil which is employed.

Rearwardly of forward coil driving assembly 7340 there is preferablyprovided a coil feeder 7353 which feeds a coil 7360 into drivingengagement with forward coil driving assembly 7340. Coil 7360 may be anysuitable coil such as those described hereinabove with reference toFIGS. 116A, 116B, 117A, 117B, 118A& 118B.

As in the embodiment of FIGS. 79 and 80B, feeder 7353 has the generalconfiguration of a funnel.

Located on a front face 7370 of housing portion 7308 and mounted on afront face 7372 of housing sub-portion 7318 and on a front face 7374 ofhousing sub-portion 7328 are quick connection mounting assemblies,respectively designated by reference numerals 7376 and 7378, which aresuitable for mounting of hands, of the type described above withreference to FIG. 27.

Front face 7370 is preferably formed with a coil outlet aperture 7380,which is defined by the respective front faces 7372 and 7374 of housingsub-portions 7318 and 7328. Coil outlet aperture 7380 preferably has aconfiguration which corresponds to the maximum cross-sectionaldimensions of the particular coil that is being employed.

Housing sub-portion 7328 is preferably formed with a vehicle dock 7382for removable docking thereto of a surgical vehicle, preferably vehicle800 (FIGS. 25A & 25B).

Intermediate housing portion 7310, disposed rearwardly of forward facinghousing portion 7308 and flexibly coupled thereto by means of flexiblecoupling 7314, preferably includes an intermediate coil driving assembly7390 mounted on housing sub-portion 7320. Assembly 7390 may be identicalin all relevant respects to assembly 7340 and its components areidentified by identical reference numerals.

Rearwardly of intermediate coil driving assembly 7390 there ispreferably provided a coil feeder 7392, which may be identical to feeder7353 and which feeds coil 7360 into driving engagement with intermediatecoil driving assembly 7390.

Housing sub-portion 7330, which forms part of intermediate housingportion 7310, is preferably formed with a vehicle dock 7394 forremovable docking thereto of a surgical vehicle, preferably vehicle 800(FIGS. 25A & 25B). Dock 7394 may be identical in all relevant respectsto dock 7382.

Rearward housing portion 7312, disposed rearwardly of intermediatehousing portion 7310 and flexibly coupled thereto by means of flexiblecoupling 7316, includes rearward housing sub-portions 7322 and 7332which together preferably define a coil storage bay 7396 for storage ofcoil 7360 in a coiled orientation therein.

It is appreciated that the overall configuration of the upstanding discreplacement coil transporter and dispenser 7300 is such that it does notfill all of the space in the third cannula subassembly and does notengage all of the tracks. In a preferred embodiment of the presentinvention, sufficient room is left free inside the third cannulasubassembly to enable operation of a surgical vehicle 800, supported ona track 504 (FIG. 22), alongside the upstanding disc replacement coiltransporter and dispenser 7300.

Preferably, the upstanding disc replacement coil transporter anddispenser 7300 also defines longitudinal recesses 7398, 7400, 7402,7404, 7406 & 7408 for mounting engagement with respective tracks 504,508, 504, 506, 504 & 506 of the third cannula subassembly as seen inFIG. 22.

Reference is now made to FIGS. 120A & 120B, which are pictorialillustrations of two different tools useful in association with theupstanding disc replacement coil transporter and dispenser of FIG. 119.

FIG. 120A describes a flexible guiding tool 7420 which comprises a base7422 which is arranged to be coupled to tool engagement element 930 ofhand 900 (FIG. 27) and a flexible batten 7424 having edge protrusions7426 and 7428 which correspond in cross-section to the cross-sections ofchannels 2675 formed in facing end plates 2024 and 2025 (FIG. 70F).

FIG. 120B describes a rigid guiding tool 7430, comprising a base 7432,which is arranged to be coupled to tool engagement element 930 of hand900 (FIG. 27) and an arm 7434, extending outwardly from base 7432 in acurved manner. Arm 7434 preferably is formed with an end portion 7436having a generally concave surface 7438 and a rounded tip 7440.

Reference is now made to FIGS. 121A and 121B and FIGS. 122A, 122B & 122Cwhich illustrate insertion and inflation of the embodiment of theinflatable implant 7000 of FIG. 114A between facing end plates ofadjacent vertebrae.

It is seen that following completion of end plate reconstruction andreinforcement to the extent required, as well as suitable end platemachining, as described hereinabove with reference to FIGS. 65A-72F, theinflatable implant 7000 is inserted between end plates 2024 and 2025 ofrespective adjacent vertebra 2004 and 2005 (FIG. 48) in recess 2402(FIG. 69A).

Insertion of the implant 7000 between end plates 2024 and 2025preferably employs a pair of pick and place tools 1322 or 1324 (FIG.29E), each preferably mounted on a surgical vehicle 800 (FIGS. 25A &25B) via hand 900 (FIG. 27), as well as an inflation tool 6818 (FIG.106B) which is pre-attached to an outward end of conduit 7057 (FIG.114A) in communication with valve 2701.

Following insertion of the implant 7000, the pick and place tools are nolonger required and may be removed.

Inflatable implant 7000, upon insertion thereof between end plates 2024and 2025 as shown in FIGS. 121A and 122A, is somewhat deflated.Subsequent inflation of the implant 7000 by means of inflation tool 6818causes expansion of implant 7000 preferably to the configuration shownin FIGS. 121B and 122B. Gauging tool 1360 is preferably employed, asdescribed hereinabove with reference to FIGS. 83A and 83B.

Alternatively or additionally marks 7470 may be placed on implant 7000and/or on adjacent vertebra to enable the orientation thereof to besensed using one or more of sensors 532 which may be associated withilluminators 533 (FIG. 20).

The information derived from the gauging tool 1360 and/or from sensors532 may be advantageously supplied to computer 148 (FIG. 2) forconfirmation purposes and also for interactive modification of the finalreal time starting operation plan.

Following inflation of the inflatable implant 7000 to a required extentas described hereinabove, tools 7420 are slidingly inserted betweenadjacent end plates 2024 and 2025, such that edge protrusions 7426 and7428 of battens 7424 thereof lie in channels 2675 of respective endplates 2024 and 2025, as shown in FIG. 122B.

Thereafter, the inflatable implant 7000 is preferably slightly deflated,to an extent that the outer dimensions of the implant 7000 are decreasedthereby tightly engaging battens 7424 between respective end plates 2024and 2025, increasing the space between the implant 7000 and battens 7424and possibly causing battens 7424 to bow slightly outwardly, whileimplant 7000 is still retained in an immobilized state in recesses 2402(FIG. 70F) in end plates 2024 and 2025, as shown in FIG. 122C.

Reference is now made to FIGS. 123-129 which illustrate seven stages inthe insertion of an upstanding disc replacement coil in accordance witha second embodiment of the present invention FIG. 123 is a pictorialview illustrating a first stage in the insertion of an upstanding discreplacement coil in accordance with a second embodiment of the presentinvention.

As seen in FIG. 123, when the inflatable implant 7000 is located betweenadjacent vertebrae 2004 and 2005 and is suitably inflated and whenupstanding disc replacement coil transporter and dispenser 7300 (FIG.119) is located adjacent vertebrae 2004 and 2005, tool 6830, mounted viaa hand 900 onto upstanding disc replacement coil transporter anddispenser 7300, may be employed to engage upstanding coil windingportion 7110 of coil 7100.

Additionally, dispenser tool 1319 is preferably employed in order toprovide a flowable bonding material to the coil winding portion 7110 asit is being coiled about inflatable implant 7000.

As seen in FIG. 123, coil 7100 is pushed by forward and rearward coildriving assemblies 7340 and 7390 respectively of the disc replacementcoil transporter and dispenser 7300 into winding engagement aroundimplant 7000 in the following manner: Tip 7102 is caused to slide alongan inner surface of an enclosure 7500 defined by the battens 7424 of apair of tools 7420.

Tool 6800 (FIG. 106A) may be employed as appropriate to push and/or pullthe coil winding portion 7110, in engagement with sockets 7118, in orderto also participate in governing the tightness of the wound coil.

FIG. 124 shows the upstanding disc replacement coil 7100 partially woundabout the inflatable implant 7000. It is seen that the coil windingportion 7110 adjacent tip 7102 is engaged by concave surface 7438 oftool 7430 to contain the coil winding portion 7110 within enclosure 7500and thus to cause it to form a second coil therewithin.

FIG. 125 shows coil 7100 loosely wound about inflatable implant 7000. Atthis stage, tool 6800, mounted via a hand 900 onto a surgical vehicle800, is operative to assist in winding the coil winding portion 7110.Additionally, dispenser tool 1319 is preferably employed in order toprovide a flowable bonding material to the coil winding portion 7110 asit is being coiled about inflatable implant 7000.

FIG. 126 shows coil 7100 more tightly wound about inflatable implant7000 through the action of forward and rearward coil driving assemblies7340 and 7390 respectively of the disc replacement coil transporter anddispenser 7300 and with the assistance of tool 6800. At this stage, theinflatable implant 7000 is again inflated preferably to the inflationlevel shown in FIG. 122B, thus freeing the battens 7424 for slidabledisengagement from recesses 2675, while at the same time applying radialoutward pressure to wound coil 7100, thus tightening it further.

FIG. 127 shows a following stage wherein through tightening produced byinflation of implant 7000 described hereinabove and/or by further actionof forward and rearward coil driving assemblies 6340 and 6390respectively of the disc replacement coil transporter and dispenser7300, protrusions 7116 engage sockets 7117 for locking the discreplacement coil portion 7110 in tightly wound engagement with theinflatable implant 7000.

It is noted that where implant 7000 (FIG. 114B) is employed with coil7200 (FIG. 116B), tightening at the stage shown in FIG. 127 may causeengagement of the ribs 7012 (FIG. 14B) and 7212 (FIG. 116B) intorecesses 7214 (FIG. 116B).

As seen in FIG. 128, laser coil cutting tool 4260 (FIG. 81D), mountedvia a hand 900 onto a surgical vehicle 800 in place of tool 6800, may beused to cut the upstanding disc replacement coil 7100 along perforation7115, thereby to detach tail 7114 from the coil winding portion 7110.

FIG. 129 shows bonding of the end 7580 of the coil winding portion 7110adjacent the location of perforation 7115 to the outer portion of thewound coil. This is preferably carried out by using tools 6830 (FIG.106C) and 6860 (FIG. 106D). Edge 6836 of tool 6830 is employed tosmooth, press and retain end 7580 against the outer portion of the woundcoil, optionally after application thereto of a bonding material bymeans of tool 1319, while tool 6860 is employed for UV curing of thebonding material applied to end 7580 either by means of tool 1319 and/orby means of passage 6850 of tool 6830.

If necessary, deflation of inflatable implant 7000 may be carried outsimilarly to the deflation described hereinabove with reference to FIGS.90A and 90B, as illustrated in FIG. 113. Following deflation, tool 6818may be detached from inflatable implant assembly 5006 by means offorceps tool 4240 (FIG. 81C), which engages grooved portion 6822 of tool6818 (FIG. 106B).

Reference is now made to FIGS. 130A, 130B, 130C, 130D, 130E, 130F and130G, which are sectional illustrations of the plurality of alternativeupstanding disc replacement coil configurations of FIGS. 102A-102G, 116A& 116B; 103A-103G, 117A & 117B; and 104A-104G, 118A & 118B installed insitu between facing vertebrae 2004 and 2005 in accordance with apreferred embodiment of the present invention.

FIG. 130A illustrates inflatable implant 5000 surrounded by upstandingdisc replacement coil 5600, in situ between end plates 2024 and 2025.

FIG. 130B illustrates inflatable implant 5500 surrounded by upstandingdisc replacement coil 5702, in situ between end plates 2024 and 2025.

FIG. 130C illustrates inflatable implant 5000 surrounded by upstandingdisc replacement coil 5900, in situ between end plates 2024 and 2025.

FIG. 130D illustrates inflatable implant 5000 surrounded by upstandingdisc replacement coil 6000, in situ between end plates 2024 and 2025,wherein recesses 6014 and 6018 face each other adjacent peripheralchannels 2678 of respective end plates 2024 and 2025. A flowable polymer4800, such as flowable polyurethane commercially available from AdvancedBio-Surfaces, Inc. of Minnetonka, Minn., U.S.A. is preferably insertedto fill the interstices between adjacent coils at recesses 6014 and 6018and peripheral channels 2678.

FIG. 130E illustrates inflatable implant 5000 surrounded by upstandingdisc replacement coil 6100, in situ between end plates 2024 and 2025,wherein top and bottom edges 6120 and 6122 (FIG. 102F) lie withinadjacent peripheral channels 2678 of respective end plates 2024 and2025. A flowable polymer 4800, such as flowable polyurethanecommercially available from Advanced Bio-Surfaces, Inc. of Minnetonka,Minn., U.S.A. is preferably inserted to fill the interstices betweenedges 6120 and 6122 and respective peripheral channels 2678.

FIG. 130F illustrates inflatable implant 5000 surrounded by upstandingdisc replacement coil 6200, in situ between end plates 2024 aid 2025,wherein top and bottom edges 6220 and 6222 (FIG. 102G) lie withinadjacent peripheral channels 2678 of respective end plates 2024 and2025. A flowable polymer 4800, such as flowable polyurethanecommercially available from Advanced Bio-Surfaces, Inc. of Minnetonka,Minn., U.S.A. is preferably inserted to fill the interstices betweenedges 6220 and 6222 and respective peripheral channels 2678.

FIG. 130G illustrates inflatable implant 2700 surrounded by upstandingdisc replacement coil 7110, in situ between end plates 2024 and 2025.Protrusions 7214 are seated in recesses 7212 in locking engagement.

Reference is now made to FIGS. 131A, 131B, 131C & 131D, which aresimplified pictorial illustrations of four variations of a filamentwound disc replacement coil constructed and operative in accordance withanother preferred embodiment of the present invention.

Referring now to FIGS. 131A, 132A and 133A, there is seen a woundfilament disc replacement assembly 8000 which is suitable for use withinflatable implant assembly 5000 described hereinabove with reference toFIGS. 100A and 101A. Wound filament disc replacement assembly 8000typically comprises a sprocket engagement belt 8002 having inwardlyfacing teeth 8004 arranged for operative engagement with the outercircular array of outwardly facing teeth 5058 of sprocket 5050. Belt8002 is intended to be assembled over sprocket 5050 and retained thereonby means of a inner facing peripheral protrusion 8006 which engagestransverse recess 5070 formed in teeth 5058 of sprocket 5050.

Extending from engagement belt 8002, and preferably integrally formedtherewith, is an filament wound coil lead portion 8010, which is formedwith an extra thick portion 8011 which, when wound about implant portion5002, seats under engagement belt 8002.

Lead portion 8010 preferably but not necessarily is formed with a fiberreinforcing layer 8012 formed of a suitable plastic or metal material.Coil lead portion 8010 preferably terminates in a filament windingportion 8013, which terminates in a tail portion 8014 which is readilyseparable therefrom by a perforation 8015.

Wound filament disc replacement assembly 8000 is preferably formed of amechanically suitable, biologically compatible elastomer such aspolyurethane. It is appreciated that along the filament winding portion,the thickness of the portion and the type of reinforcement providedthereto may vary, as may the material composition and othercharacteristics thereof. Furthermore, the width of the filament windingportion 8013 may vary therealong such that the thickness of the filamentwound coil at various locations thereat corresponds to the desiredconfiguration of the resulting replacement disc.

Additionally or alternatively, the mechanical properties of the filamentwinding portion 8013 may vary therealong. This may be achieved byforming voids or recesses 8018 at various locations in the coil windingportion, to reduce the rigidity and/or to increase the bendabilityand/or elasticity of the filament winding portion thereat.

It is appreciated that the width of engagement belt 8002 is preferablymore than that of most of filament winding portion 8010, in order toenable the engagement belt to be readily easily inserted between thevertebrae when slipped over sprocket 5050 when the inflatable implantportion 5002 is not yet fully inflated; while the filament windingportion 8013 is of a cross-sectional configuration suitable forproviding desired flexibility in sculpturing the filament woundreplacement disc as will be described hereinbelow. vertebrae followingfurther inflation of the inflatable implant portion 5002.

Wound filament disc replacement assembly 8000 is normally wound aboutinflatable implant portion 5002 by rotation of sprocket 5050 in aclockwise direction in the sense of FIGS. 100A and 131A. This causes thelead portion 8010 to be tightly wound about the engagement belt 8002 andthus about the inflatable implant portion 5002. The filament windingportion 8013 is subsequently wound in a desired configuration over thelead portion 8010.

Preferably, the filament winding portion 8013 may be retained in adesired wound arrangement by means of mechanical and/or adhesiveengagement between adjacent portions thereof.

In the embodiment shown in FIGS. 131A, 132A and 133A, thecross-sectional configuration of the filament winding portion 8013 isgenerally rectangular.

FIGS. 131B, 132B & 133B illustrate an alternative embodiment of afilament wound disc replacement coil assembly, here designated byreference numeral 8100, which is suitable for use with inflatableimplant assembly 5000 described hereinabove with reference to FIGS. 100Aand 101A. This embodiment is identical to that of FIGS. 131A, 132A &133A except in that the cross-sectional configuration of the filamentwinding portion thereof designated by reference numeral 8113, isnon-rectangular and preferably round.

FIGS. 131C, 132C & 133C illustrate another alternative embodiment of afilament wound disc replacement coil assembly, here designated byreference numeral 8200, which is suitable for use with inflatableimplant assembly 5000 described hereinabove with reference to FIGS. 100Aand 101A. This embodiment is identical to that of FIGS. 131B, 132B &133B except in that the filament winding portion thereof designated byreference numeral 8213, is formed with a multiplicity of variouslydirected protrusions 8214 along all or part of the length thereof toassist in holding the resulting filament wound coil together in adesired configuration.

FIGS. 131D, 132D & 133D illustrate yet another alternative embodiment ofa filament wound disc replacement coil assembly, here designated byreference numeral 8300, which is suitable for use with inflatableimplant assembly 5000 described hereinabove with reference to FIGS. 100Aand 101A. This embodiment is identical to that of FIGS. 131C, 132C &133C except in that the filament winding portion thereof designated byreference numeral 8313, is formed with a multiplicity of variouslydirected protrusions of two distinct types along all or part of thelength thereof. Protrusions 8314 define engagement elements having abroadened end portion 8315, and protrusions 8316 define hooks whichengage the engagement elements for enhanced mutual engagementtherebetween, thereby to assist in holding the resulting filament woundcoil together in a desired configuration.

Reference is now made to FIG. 134, which is a pictorial illustration inexploded view format of an filament wound disc replacement transporterand dispenser 8400 constructed and operative in accordance with apreferred embodiment of the present invention.

The disc replacement transporter and dispenser 8400 preferably includesa housing 8402 which is preferably formed of first and second joinedhousing portions 8404 and 8406.

The housing 8402 preferably comprises a plurality of mutuallyarticulated portions 8408, 8410 and 8412, which are preferably joined byflexible couplings 8414 and 8416. It may thus be appreciated that eachof housing portions 8404 and 8406 preferably includes three housingsub-portions, designated respectively as 8418, 8420 and 8422 for housingportion 8404 and 8428, 8430 and 8432 for housing portion 8406. Housingportion 8408 is preferably the forward facing housing portion.

Located on a front face 8470 of housing portion 8408 and mounted on afront face 8472 of housing sub-portion 8418 and on a front face 8474 ofhousing sub-portion 8428 are quick connection mounting assemblies,respectively designated by reference numerals 8476 and 8478, which aresuitable for mounting of hands, of the type described above withreference to FIG. 27.

Front face 8470 is preferably formed with a filament outlet and drivingbelt accommodating aperture 8480, which is defined by the respectivefront faces 8472 and 8474 of housing sub-portions 8418 and 8428.Filament outlet and driving belt accommodating aperture 8480 preferablyhas a configuration which is larger than the maximum cross-sectionaldimensions of the particular wound filament disc replacement assemblythat is being employed and is sufficiently large to accommodate drivingbelt 5056 (FIG. 100A).

Housing sub-portion 8428 is preferably formed with a vehicle dock 8482for removable docking thereto of a surgical vehicle, preferably vehicle800 (FIGS. 25A & 25B).

Intermediate housing portion 8410 is disposed rearwardly of forwardfacing housing portion 8408 and is flexibly coupled thereto by means offlexible coupling 8414.

Housing sub-portion 8430, which forms part of intermediate housingportion 8410, is preferably formed with a vehicle dock 8494 forremovable docking thereto of a surgical vehicle, preferably vehicle 800(FIGS. 25A & 25B). Dock 8494 may be identical in all relevant respectsto dock 8482.

Rearward housing portion 8412, disposed rearwardly of intermediatehousing portion 8410 and flexibly coupled thereto by means of flexiblecoupling 8416, includes rearward housing sub-portions 8422 and 8432which together preferably define a filament storage bay 8496 for storageof a filament winding portion 8513 in a coiled orientation therein.Filament winding portion 8513 may be part of any suitable filament wounddisc replacement coil assembly, such, such as those describedhereinabove with reference to FIGS. 131A-131D, 132A-132D and 133A-133D.

Filament winding portion 8513 may comprise any suitable filament. Apreferred filament may employ biomaterials described on a web site ofProtein Polymer Technologies, Inc. identified as http://www.ppti.com.

It is also appreciated that such biomaterials or materials similarthereto may advantageously be used to form some or all of the implantsemployed in the present invention. Such biomaterials may be employed, incertain circumstances together with biological materials earlier removedfrom the patient, such as during disc suctioning.

It is appreciated that the overall configuration of the disc replacementtransporter and dispenser 8400 is such that it does not fill all of thespace in the third cannula subassembly and does not engage all of thetracks. In a preferred embodiment of the present invention, sufficientroom is left free inside the third cannula subassembly to enableoperation of a surgical vehicle 800, supported on a track 504 (FIG. 22),alongside the disc replacement transporter and dispenser 8400.Preferably, the disc replacement transporter and dispenser 8400 alsodefines longitudinal recesses 8518, 8520, 8522, 8524, 8526 & 8528 formounting engagement with respective tracks 504, 508, 504, 506, 504 & 506of the third cannula subassembly as seen in FIG. 22.

Driving belt 5056 is preferably driven by a sprocket drive assembly8537, typically comprising an electric motor 8538, controlled bymulti-functional controller 253 (FIG. 7) and a sprocket 8539, driven bymotor 8538. Sprocket drive assembly 8537 is operative to drive drivingbelt 5056, via a plurality of fairleads 8540.

Disposed in intermediate housing portion 8410 there is preferablyprovided an adhesive container and dispenser 8550, through which thefilament 8513 passes, thus becoming impregnated and/or coated withadhesive.

Reference is now made to FIGS. 135A and 135B, which are pictorialillustrations of two different tools useful in association with thefilament wound disc replacement coil transporter and dispenser of FIG.134.

FIG. 135A illustrates a multi-functional filament orienting and coating& pick and place tool, here designated by reference numeral 8630, whichmay be employed in association with universal hand 900 and removably andreplaceably coupled to tool engagement element 930 thereof (FIG. 27).Tool 8630 typically comprises a base 8632, which is arranged to becoupled to tool engagement element 930 of hand 900 (FIG. 27), a bodyportion 8633 extending therefrom, and an arm 8634 extending outwardlyfrom body portion 8633 in a curved manner and having a rounded serratedtip 8636.

A filament coating passage 8650 is provided for supplying a liquidcoating material to the filament winding portion 8513 (FIG. 134) as thefilament passes therethrough. The liquid coating material may be an insitu polymerizable polymer which, when polymerized becomes a elastomericbond substance.

A preferred material is a flowable polyurethane commercially availablefrom Advanced Bio-Surfaces, Inc. of Minnetonka, Minn., U.S.A. Thestructure of filament coating passage 8650 and the supply of liquidcoating material thereto via a liquid supply conduit 8652 may be similarto those described hereinabove with reference to the embodiment of FIG.81B.

FIG. 135B illustrates a filament winding assistance tool, heredesignated by reference numeral 8660, which may be employed inassociation with universal hand 900 and removably and replaceablycoupled to tool engagement element 930 thereof (FIG. 27). Tool 8660typically comprises a base 8662 which is arranged to be coupled to toolengagement element 930 of hand 900 (FIG. 27) and an arm 8664 extendingoutwardly from base 8662 in a curved manner.

An outwardly extending rake 8666 is provided at an end of arm 8664,opposite to the end of arm 8664 which is attached to base 8662. Rake8666 is configured to cooperate with multi-functional tool 8630 forassisting in the winding and desired placement of the filament 8513thereby to provide a desired sculpturing functionality.

Extending backwardly from rake 8666 there may be provided a roundedserrated tip 8668, which also may be used for assisting in the windingand desired pressing of the filament 8513 thereby to provide a desiredsculpturing functionality.

Reference is now made to FIGS. 136A and 136B, which are simplifiedpictorial illustrations of insertion and inflation of an inflatableimplant assembly between facing end plates of adjacent vertebrae inaccordance with another embodiment of the present invention.

It is seen that following completion of end plate reconstruction andreinforcement to the extent required, as well as suitable end platemachining, as described hereinabove with reference to FIGS. 65A-72B, theinflatable implant assembly 5000, preferably having a circular implantportion 8700 and having the engagement belt 8002 of wound filament discreplacement coil assembly 8000 engaging teeth 5058 of sprocket 5050 andhaving the driving belt 5056 which is drivingly coupled to discreplacement transporter 8400 engaging teeth 5054 of sprocket 5050thereof is inserted between end plates 2024 and 2025 of respectiveadjacent vertebra 2004 and 2005 (FIG. 48) in recess 2402 and channel2610 (FIG. 70B).

Insertion of the implant assembly 5000, having the engagement belt 8002of disc replacement assembly 8000 engaged therewith, between end plates2024 and 2025 preferably employs tools 1324 (FIG. 29E) and 8630 (FIG.135A). Tool 1324 is preferably mounted on a surgical vehicle 800 (FIGS.25A & 25B) via a hand 900 (FIG. 27).

Tool 8630 is preferably mounted on disc replacement transporter anddispenser 8400 via a hand 900 (FIG. 27) and is positioned betweenengagement belt 8002 and lead portion 8010. At this stage, discreplacement transporter and dispenser 8400 contains filament windingportion 8513 in an orientation ready for winding as well as driving belt5056 in an orientation ready for driving the sprocket 5050 of implantassembly 5000.

Inflation tool 6818 (FIG. 106B) is premounted onto implant assembly 5000and is operatively coupled thereto via valve 5006 (FIG. 100A).

Inflatable implant portion 8700 of inflatable implant assembly 5000,upon insertion thereof between end plates 2024 and 2025 as shown in FIG.136A, is somewhat deflated. Subsequent inflation of the implant portion8700 by means of inflation tool 6818 causes expansion of implant portion8700 preferably to the configuration shown in FIG. 136B. Gauging tool1360 (FIG. 29G) is preferably employed, as shown in FIG. 136B, formeasuring the extent of inflation of the implant portion 8700 and/or theresulting separation between adjacent vertebrae.

Alternatively or additionally marks 8702 may be placed on implantportion 8700 and/or on adjacent vertebra to enable the orientationthereof to be sensed using one or more of sensors 532 which may beassociated with illuminators 533 (FIG. 20).

The information derived from the gauging tool 1360 and/or from sensors532 may be advantageously supplied to computer 148 (FIG. 2) forconfirmation purposes and also for interactive modification of the finalreal time starting operation plan.

Reference is now made to FIG. 137, which is a pictorial viewillustrating a first stage in the insertion of an filament wound discreplacement in accordance with another embodiment of the presentinvention.

As seen in FIG. 137, when the inflatable implant assembly 5000 islocated between adjacent vertebrae 2004 and 2005 and is suitablyinflated and when disc replacement transporter and dispenser 8400 (FIG.134) is located adjacent vertebrae 2004 and 2005, lead portion 8610already having been wound about inflatable implant portion 8700, tool8630, mounted via a hand 900 onto disc replacement transporter anddispenser 8400, may be employed to engage filament 8513 for desiredpositioning of filament 8513 as it is wound about inflatable implantportion 8700. For this purpose, tool 8630 may be positioned adjacentvertebra 2004 and 2005 rather than therebetween as at the previousstage, shown in FIG. 136A.

During this time, tool 8660, mounted via a hand 900 onto a surgicalvehicle 800, is operative to assist in winding the filament windingportion 8513.

Additionally, dispenser tool 1319 may be employed in order to provideadditional flowable bonding material to the wound filament, coiled aboutinflatable implant portion 8700.

Tool 8660 (FIG. 135B) may be employed as appropriate to assist inpositioning the filament winding portion 8513, in cooperation with theoperation of tool 8630.

Reference is now made to FIG. 138, which is a pictorial viewillustrating a second stage in the insertion of the filament wound discreplacement.

As seen in FIG. 138, tools 8630 and 8660 produce winding of the filament8513 in a manner such that filament crossovers, indicated by referencenumeral 8710 occur generally in a desired given region, designated byreference numeral 8712, which may be identified in planning and carryingout the operation by reference to a system of polar coordinates,designated by reference numeral 8714, centered at the center of theinflatable implant 8700, as shown in FIG. 138, which system of polarcoordinates is preferably fixed with reference to coordinate system TVreference to hereinabove.

Reference is now made to FIG. 139, which is a pictorial viewillustrating a third stage in the insertion of the filament wound discreplacement.

As seen in FIG. 139, tools 8630 and 8660 produce winding of the filament8513 in a manner such that filament crossovers, indicated by referencenumeral 8710 occur generally in multiple regions, designated byreference numerals 8720 and 8722, which may be identified in planningand carrying out the operation by reference to the system of polarcoordinates, designated by reference numeral 8714. It may thus beappreciated that by selecting the number and location of the crossovers8710 about the inflatable implant 8700, the configuration of the woundfilament disc replacement may thus be determined.

Reference is now made to FIG. 140, which is a pictorial viewillustrating a fourth stage in the insertion of the filament wound discreplacement. It is appreciated that this stage may be in addition to orinstead of the second and third stages.

As seen in FIG. 140, and as discussed hereinabove with reference to FIG.131A, filament winding portion 8013 may be constructed to have across-sectional configuration which varies along its length, as seenparticularly at reference numerals 8730 and 8732. It may thus beappreciated that by selecting the number, type and location of thevariations in cross-section, the configuration of the wound filamentdisc replacement may thus be determined. Furthermore, filament coils,such as those illustrated at reference numerals 8740 and 8742 may belocated within corresponding undercut recesses 8744 and 8746 machinedinto respective end plates 2024 and 2025, thus providing a desiredinterconnection therewith.

Reference is now made to FIG. 141, which is a pictorial viewillustrating a fifth stage in the insertion of the filament wound discreplacement. It is appreciated that this stage may be in addition to orinstead of the second, third and fourth stages described hereinabove.

As seen in FIG. 141, tools 8630 and 8660 may be employed to producewinding of the filament 8013 in a manner such that the number offilament coils may vary at different distances along the separationbetween adjacent vertebra 2004 and 2005, as indicated by referencenumerals 8736 and 8738.

It may be appreciated that the use of filaments employing biomaterials,such as those described on a web site of Protein Polymer Technologies,Inc. identified as http:/www.ppti.com, may be particularly beneficialwhen it is desired that such filaments be located within undercutrecesses 8744 and 8746 and biologically form a single mass together withthe end plates.

It may be appreciated that by combining the functionalities describedhereinabove with reference to FIGS. 138-141 one may realize the abilityto effectively sculpt the wound filament replacement disc by varyingthree operational parameters. Furthermore, by varying the mechanicalcharacteristics of the filament, additional freedom of design may berealized. For example, the hardness and flexibility of the woundfilament replacement disc may vary in a predetermined manner at variouslocations therein, thus influencing for example the range and ease ofarticulation thereof.

Reference is now made to FIG. 142, which is a pictorial viewillustrating a sixth stage in the insertion of the wound filamentreplacement disc. As seen in FIG. 142, laser coil cutting tool 4260(FIG. 81D), mounted via a hand 900 onto a surgical vehicle 800 in placeof tool 8660, may be used to cut the filament winding portion 8013 alongperforation 8015, thereby to detach tail 8014 therefrom.

FIG. 143 shows bonding of the end 8750 of the filament winding portion8013 adjacent the location of perforation 8015 to the outer portion ofthe wound filament. This is preferably carried out by using tools 8630(FIG. 135A) and 6860 (FIG. 106D). Edge 8636 of tool 8630 is employed tosmooth, press and retain end 8750 against the outer portion of the woundfilament, optionally after application thereto of a bonding material bymeans of tool 1319, while tool 6860 is employed for UV curing of thebonding material applied to end 8750 either by means of tool 1319 and/orby means of passage 8650 of tool 8630.

If necessary, deflation of inflatable implant 8700 may be carried outsimilarly to the deflation described hereinabove with reference to FIGS.90A and 90B, as illustrated in FIG. 144. Following deflation, tool 6818may be detached from inflatable implant assembly 5000 by means offorceps tool 4240 (FIG. 81C), which engages grooved portion 6822 of tool6818 (FIG. 106B).

Reference is now made to FIG. 145, which is a sectional illustration ofa filament wound disc replacement installed in situ between facingvertebrae 2004 and 2005 in accordance with a preferred embodiment of thepresent invention.

FIG. 145 illustrates inflatable implant 5000 surrounded by filamentwound disc replacement portion 8013, in situ between end plates 2024 and2025, wherein the filament winding also is wound within adjacentperipheral channels 2678 of respective end plates 2024 and 2025.

Reference is now made to FIGS. 146A, 146B, 146C, 146D & 146E and toFIGS. 147A, 147B, 147C, 147D & 147E, which illustrate five variations ofan inflatable implant constructed and operative in accordance withanother preferred embodiment of the present invention. The inflatableimplant of FIGS. 146A and 147A, designated by reference numeral 9000,may be identical to the inflatable implant described above withreference to FIG. 75A.

Inflatable implant 9000 is preferably formed of a mechanically suitable,biologically compatible elastomer such as polyurethane by conventionalblow molding techniques preferably having integrally formed therewith anelongate inflation conduit 9001. Conduit 9001 preferably has across-sectional configuration which is adapted to fit the contours ofchannel 2610 (FIG. 69B). Conduit 9001 preferably extends to theperiphery of the end plates 2024 and 2025 and enables inflation anddeflation of the inflatable implant 9006 from a location outside of theend plates via a conventional inflation valve 9002.

A bean shaped configuration is preferred because it generallycorresponds to the cross-sectional configuration of the end plates 2024and 2025 of the vertebra. For the purposes of ease of description, theouter surface of inflatable implant 9000 is considered herein as havingfirst and second slightly curved generally planar surfaces 9003 and 9004and first and second intermediate edge surfaces 9006 and 9008, it beingunderstood that edge surfaces 9006 and 9008 are joined together so as todefine a complete peripheral edge surface and are joined with surfaces9003 and 9004 in a generally seamless manner to define a smooth outersurface for the implant.

As seen particularly in FIG. 147A, the slightly curved generally planarsurfaces 9003 and 9004 and intermediate edge surfaces 9006 and 9008 arecurved to correspond to the configuration of the recess 2402 formed ineach end plate for secure seating therein, optimized distribution ofpressure and forces thereon and shock absorbing.

Reference is now made to FIGS. 146B & 147B, which illustrate anotherinflatable implant, designated by reference numeral 9010, constructedand operative in accordance with a preferred embodiment of the presentinvention. This implant may be identical in all relevant respects toimplant 9000, described hereinabove with reference to FIGS. 146A & 147Bwith the addition of a generally bandlike peripheral protrusion 9012having undercut peripheral edges 9014 and 9016.

Reference is now made to FIGS. 146C & 147C, which illustrate yet anotherinflatable implant, designated by reference numeral 9020, constructedand operative in accordance with a preferred embodiment of the presentinvention. This implant may be identical in all relevant respects toimplant 9010, described hereinabove with reference to FIGS. 146B & 147Bbut wherein a peripheral protrusion 9022 has peripheral edges 9024 and9026 which are not undercut.

Reference is now made to FIGS. 146D & 147D, which illustrate stillanother inflatable implant, designated by reference numeral 9030,constructed and operative in accordance with a preferred embodiment ofthe present invention. This implant may be identical in all relevantrespects to implant 9020, described hereinabove with reference to FIGS.146C & 147C but wherein the bandlike protrusion is replaced by twodiscrete protrusions 9032 and 9034 on respective edge surfaces 9006 and9008.

Reference is now made to FIGS. 146E & 147E, which illustrate a furtherinflatable implant, designated by reference numeral 9040, having aperipheral bandlike protrusion 9042 and which is constructed andoperative in accordance with a preferred embodiment of the presentinvention. This implant may be identical in all relevant respects toimplant 9020, described hereinabove with reference to FIGS. 146C & 147Cwith the difference that the protrusion 9042 is wider than correspondingprotrusion 9022 and that the implant has a greater cross-sectionalthickness than implant 9020.

Reference is now made to FIGS. 146F & 147F, which illustrate anadditional implant, designated by reference numeral 9050. Implant 9050preferably has a cross-sectional configuration which is adapted to fitthe contours of channel 2610 (FIG. 69B). Implant 9050 preferably extendsto the periphery of the end plates 2024 and 2025 and enables injectionof body substances earlier removed from the nucleus pulposus to theregion between the end plates 2024 and 2025.

Such body material which may be processed before being injected, issupplied to implant 9050 via a valve 9052, which is coupled to aninterior conduit 9054 having an outlet 9056 in communication with theregion between the end plates 2024 and 2025. Preferably a tool, such astool 1350 (FIG. 29F) is used for this purpose.

Reference is now made to FIG. 148, which is a pictorial illustration ofa generic disc replacement band 9100 constructed and operative inaccordance with an embodiment of the invention and useful with theinflatable implants of FIGS. 146A-147E. It is appreciated that aplurality of disc replacement bands 9100 of different sizes is used todefine a disc replacement band subassembly in accordance with preferredembodiment of the present invention.

As will be described hereinbelow, this subassembly, when combined withan inflatable implant, such as those one of the implants describedhereinabove with reference to FIGS. 146A-146D and 147A-147D constitutesan disc replacement band implant assembly. It is further appreciatedthat each of the disc replacement bands 9100 preferably has an overallconfiguration generally corresponding to the bean-shaped configurationof the peripheral edge of the inflatable implant defined by edgesurfaces 9006 and 9008 thereof.

Preferably each of bands 9100 is formed with an aperture 9104 on anouter facing side surface thereof for engagement by a tool describedhereinbelow with reference to FIG. 154D. Preferably each of bands 9100is also formed with retaining sockets 9106 on an inner facing side surgethereof. Preferably two pairs of sockets 9106 are disposed in oppositemutually facing relationship.

The disc replacement band 9100 is preferably formed of a mechanicallysuitable, biologically compatible elastomer such as polyurethane and maybe formed with a fiber reinforcing layer and/or at least one compressionwire formed of a suitable plastic or metal material.

Reference is now made to FIGS. 149A, 149B, 149C, 149D & 149E, which aresimplified sectional illustrations of variations of the band of FIG.148, taken along a line CXXXXIX-CXXXXIX thereon.

The disc replacement band 9201 of FIG. 149A is a solid band havingrespective top and bottom peripheral protrusions 9202 and 9204 ofgenerally partially circular cross-section and inner and outer sidesurfaces 9206 and 9208 which are respectively concave and convex.

The disc replacement band 9211 of FIG. 149B is a solid band havingrespective top and bottom peripheral protrusions 9212 and 9214 ofgenerally partially circular cross-section and inner and outer sidesurfaces 9216 and 9218 which respectively bear a peripheral undercutprotrusion 9220 and peripheral undercut socket 9222, having undercut topand bottom edges.

The disc replacement band 9231 of FIG. 149C is a solid band havingrespective top and bottom peripheral protrusions 9232 and 9234 ofgenerally partially circular cross-section and inner and outer sidesurfaces 9236 and 9238. Inner side surface 9236 is identical to innerside surface 9216 of the embodiment of FIG. 149B and is formed with aperipheral undercut socket 9239, while outer side surface 9238 isidentical to outer side surface 9208 of the embodiment of FIG. 149A.

The disc replacement band 9241 of FIG. 149D is a solid band havingrespective top and bottom peripheral protrusions 9242 and 9244 ofgenerally partially circular cross-section and inner and outer sidesurfaces 9246 and 9248 which respectively bear peripheral sockets 9250and 9252, having undercut top and bottom edges.

The disc replacement band 9261 of FIG. 149E is a hollow band having avoid 9262 and having respective top and bottom peripheral protrusions9263 and 9264 of generally partially circular cross-section and innerand outer side surface 9266 and 9268 which are respectively concave andconvey.

Reference is now made to FIGS. 150 and 151, which illustrate discreplacement band 9300 constructed and operative in accordance withanother embodiment of the invention, which is useful with the inflatableimplant of FIGS. 146D & 147D. Band 9300 may be identical to band 9100with the additional provision of respective recesses 9332 and 9334 attwo facing inner side surface locations which are adapted to receiveprotrusions 9032 and 9034 of inflatable implant 9030 shown in FIGS. 146Dand 147D.

Disc replacement band 9300 preferably has a configuration at recesses9332 and 9334 as illustrated in FIG. 151, including a generally concaveinner side surface 9336 and a generally convex outer side surface 9338.Recesses 9332 and 9334 are defined by tapering surface 9340 and 9342which terminate at an inner surface 9344.

Preferably each of bands 9300 is formed with an aperture 9354 on anouter facing side surface thereof for engagement by a tool describedhereinbelow with reference to FIG. 154D. Preferably each of bands 9300is also formed with retaining sockets 9356 on an inner facing sidesurface thereof. Preferably two pairs of sockets 9356 are disposed inopposite mutually facing relationship.

The disc replacement band 9300 of FIGS. 150 & 151 is a solid band havingrespective top and bottom peripheral protrusions 9362 and 9364 ofgenerally partially circular cross-section.

The disc replacement band 9300 is preferably formed of a mechanicallysuitable, biologically compatible elastomer such as polyurethane and maybe formed with a fiber reinforcing layer and/or at least one compressionwire formed of a suitable plastic or metal material.

Reference is now made to FIG. 152, which is a pictorial illustration ofa generic disc replacement band 9400 constructed and operative inaccordance with yet another embodiment of the invention and useful withthe inflatable implant of FIGS. 146C & 147C. It is appreciated that aplurality of disc replacement bands 9400 of different sizes is used todefine a disc replacement band subassembly in accordance with preferredembodiment of the present invention.

As will be described hereinbelow, this subassembly, when combined withan inflatable implant, such as those one of the implants describedhereinabove with reference to FIGS. 146A-146D and 147A-147D constitutesa disc replacement band implant assembly. It is further appreciated thateach of the disc replacement bands 9400 preferably has an overallconfiguration generally corresponding to the bean-shaped configurationof the peripheral edge of the inflatable implant defined by edgesurfaces 9006 and 9008 thereof.

Preferably each of bands 9400 is formed with an aperture 9402 on anouter facing side surface thereof for engagement by a tool describedhereinbelow with reference to FIG. 154D. Additionally, each of bands9400 is formed with preferably two valves 9404 and 9405 for injection ofa flowable polymer, as by means of a tool described hereinbelow withreference to FIG. 154E. Preferably each of bands 9400 is also formedwith retaining sockets 9406 on an inner facing side surface thereof.Preferably two pairs of sockets 9406 are disposed in opposite mutuallyfacing relationship.

The flowable polymer may be any suitable polymer, preferablypolyurethane and may include reinforcing whiskers or other reinforcingelements formed of any suitable material.

The disc replacement band 9400 is preferably formed of a mechanicallysuitable, biologically compatible elastomer such as polyurethane and maybe formed with a fiber reinforcing layer and/or at least one compressionwire formed of a suitable plastic or metal material.

Reference is now made to FIGS. 153A & 153B, which are simplifiedsectional illustrations of variations of the band 9400 of FIG. 152. Thedisc replacement band 9407 of FIG. 153A has a generally U-shapedcross-section defining a slightly convex outer side surface 9408 and arespective generally flat top and bottom surfaces 9410 and 9412 defininginwardly facing edges 9414 and 9416 having a cross-sectional curvaturewhich preferably match the configuration of peripheral edges 9024 and9026 of inflatable implant 9020 (FIGS. 146C and 147C).

In accordance with a preferred embodiment of the present invention thetop and bottom surfaces 9410 and 9412 are formed with respectiveapertures 9420 and 9422, distributed along the circumference of the band9400. Flowable polymers, injected using valves 9405 and 9406 into spacesbetween adjacent bands 9400 and between inflatable implant 9020 and aband 9400, flows outwardly through apertures 9420 and 9422 into undercutrecesses, such as recesses 2673 and 2675 (FIG. 70F) in end plates 2024,as will be described hereinbelow.

The disc replacement band 9427 of FIG. 153B may be identical to band9407 of FIG. 153A other than in that it is preferably provided withouter facing top and bottom corner edge recesses 9430 and 9431 as wellas apertures 9432 distributed along the circumference of its sidesurface 9433. Band 9247 thus includes respective generally flat top andbottom surfaces 9434 and 9435 defining inwardly facing edges 9436 and9437.

The top and bottom surfaces 9434 and 9435 are formed with respectiveapertures 9438 and 9439, distributed along the circumference of the band9427. As will be described hereinbelow, flowable polymers, injectedusing valves 9405 and 9406 into the space between inflatable implant9020 and a band 9407, flows inwardly through apertures 9432 into thespace between bands 9407 and 9427.

Reference is now made to FIGS. 154A, 154B, 154C, 154D, 154E, 154F and154G, which are pictorial illustrations of tools which are employed inassociation with the hand of FIG. 27 for use with the inflatableimplants and disc replacement bands of FIGS. 146A-153B.

FIG. 154A describes a flexible guiding tool 9420 which comprises a baseportion 9440 including a mounting aperture 9442 which is arranged to beengaged by a tool described hereinbelow with reference to FIG. 154B.Integrally formed with base portion 9440 is a flexible batten 9444having edge protrusions 9446 and 9448 which correspond in cross-sectionto the cross-sections of channels 2675 formed in facing end plates 2024and 2025 (FIG. 70F).

Reference is now made to FIG. 154B, which illustrates a forceps tool9513 which may be employed in association with universal hand 900 andremovably and replaceably coupled to tool engagement element 930 thereof(FIG. 27). Forceps tool 9513 typically comprises a base 9514 onto whichis preferably fixedly mounted one forceps finger 9515. A second forcepsfinger 9516 is mounted for selectable positioning with respect toforceps finger 9515, such as in an off-axis arrangement on a drive shaft9517 of a motor 9518 which may be controlled directly bymulti-functional controller 253 (FIG. 7).

Forceps tool 9513 is characterized in that the forceps fingers 9515 and9516 are relatively thin and in that one of the mutually facing surfaces9520 and 9522 is formed with a protrusion 9524, while the other isformed with a cooperating and correspondingly positioned and configuredrecess 9526.

FIG. 154C illustrates a disc replacement band engagement tool, heredesignated by reference numeral 9540, which may be employed inassociation with universal hand 900 and removably and replaceablycoupled to tool engagement element 930 thereof (FIG. 27). Tool 9540typically comprises a base 9542, which is arranged to be coupled to toolengagement element 930 of hand 900 (FIG. 27), and an arm 9544 extendingoutwardly from base 9542 and which terminates in a rounded tip 9546.

Formed along both opposite side surfaces 9548 and 9550 of arm 9544 thereare provided pairs of protrusions, respectively designated 9552 and9554, which protrusions are adapted for operative engagement withretaining sockets 9106 (FIG. 148), 9356 (FIG. 150) and 9406 (FIG. 152).

Preferably arm 9544 is formed with a first portion 9556 which extendsoutwardly from base 9542 and a generally flattened portion 9558, whichextends outwardly from first portion 9556.

FIG. 154D illustrates another disc replacement band engagement tool,here designated by reference numeral 9560, which may be employed inassociation with vehicle 850 and removably and replaceably coupled to aquick connector 874 thereof. Tool 9560 typically comprises a base 9562,which is arranged to be coupled to quick connector 874 of a vehicle 850,and a bent arm 9564 extending outwardly from base 9562 and whichterminates in a cylindrical pin 9566, which is adapted for engagementwith aperture 9104 of band 9100 (FIG. 148), aperture 9354 of band 9300(FIG. 150) and aperture 9402 of band 9400 (FIG. 152).

FIG. 154E describes a tool 9570 useful for supplying a flowable polymerto disc replacement band 9400 (FIG. 152). Preferably, tool 9570 includesa base 9572, which is arranged to be coupled to a vehicle 800, and apair of nozzles 9574 and 9576, mounted on base 9572 and adapted forengagement with respective valves 9404 and 9405 (FIG. 152). Nozzle 9574is coupled to a conduit 9578, which receives a pressurized supply offlowable polymer, and supplies that polymer via outlets 9580 throughvalve 9404 to the interior of band 9400.

In order to enhance the efficiency of injection of the flowable polymer,simultaneously with injection of the flowable polymer via valve 9404, anegative pressure is applied to another location at the interior of band9400 via valve 9405 and nozzle 9576, which is coupled to a vacuumconduit 9582, coupled to a negative pressure source (not shown).

FIG. 154F describes a tool 9590 useful for inserting an inflatableimplant, such as those described hereinabove with reference to FIGS.146A-146C and 147A-147C, while retained in a folded orientation. Tool9590 comprises a base portion 9592 including a mounting aperture 9594which is arranged to be engaged by tool 9513 (FIG. 154B). Integrallyformed with base portion 9592 is a generally cylindrical retainingportion 9596.

Reference is now made to FIGS. 155A, 155B & 155C and 156A, 156B, 156C &156D which illustrate insertion, inflation and removal of the inflatableimplants of any of FIGS. 146A-146E and 147A-147E at facing end plates ofadjacent vertebrae. For the sake of clarity and conciseness, theinflatable implant 9000 (FIGS. 146A & 147A) is illustrated in FIGS.155A, 155B & 155C and 156A, 156B, 156C & 156D.

It is seen that following completion of end plate reconstruction andreinforcement to the extent required, as well as suitable end platemachining, as described hereinabove with reference to FIG. 70F, theinflatable implant 9000 is inserted between end plates 2024 and 2025 ofrespective adjacent vertebra 2004 and 2005 (FIG. 48) in recess 2402(FIG. 70F).

Insertion of the implant 9000 between end plates 2024 and 2025preferably employs a pair of pick and place tools 1322 or 1324 (FIG.29E), each preferably mounted on a surgical vehicle 800 (FIGS. 25A &25B) via hand 900 (FIG. 27), as well as an inflation tool 6818 (FIG.106B) which is pre-attached to an outward end of conduit 9001 (FIG.146A) in communication with valve 9002. Following insertion of theimplant 9000, the pick and place tools are no longer required and may beremoved.

Inflatable implant 9000, upon insertion thereof between end plates 2024and 2025 as shown in FIGS. 155A and 156A, is somewhat deflated.Subsequent inflation of the implant 9000 by means of inflation tool 6818causes expansion of implant 9000 preferably to the configuration shownin FIGS. 155B and 156B. Gauging tool 1360 is preferably employed, asdescribed hereinabove with reference to FIGS. 82B and 83B.

Alternatively or additionally marks 9600 may be placed on implant 9000and/or on adjacent vertebra to enable the orientation thereof to besensed using one or more of sensors 532 which may be associated withilluminators 533 (FIG. 20).

The information derived from the gauging tool 1360 and/or from sensors532 may be advantageously supplied to computer 148 (FIG. 2) forconfirmation purposes and also for interactive modification of the finalreal time starting operation plan.

Following inflation of the inflatable implant 9000 to a required extentas described hereinabove, tools 9420 are slidingly inserted betweenadjacent end plates 2024 and 2025 by means of forceps tools 9513, suchthat edge protrusions 9446 and 9448 of battens 9444 thereof lie inchannels 2408 of respective end plates 2024 and 2025, as shown in FIG.155B.

Thereafter, the inflatable implant 9000 is preferably slightly deflated,to an extent that the outer dimensions of the implant 9000 are decreasedthereby tightly engaging battens 9444 between respective end plates 2024and 2025, increasing the space between the implant 9000 and battens 9444and possibly causing battens 9444 to bow slightly outwardly, whileimplant 9000 is still retained in an immobilized state in recesses 2402(FIG. 70F) in end plates 2024 and 2025, as shown in FIG. 156C.

Referring now to FIGS. 155C and to 156D, it is seen that implant 9000 isthen generally completely deflated and removed from the region betweenrespective end plates 2024 and 2025.

Reference is now made to FIGS. 157, 158, 159 & 160, which are simplifiedpictorial illusions of four stages in the insertion of the discreplacement bands of FIGS. 148A-153B between facing end plates ofadjacent vertebrae, following removal of implant 9000. For the sake ofclarity and conciseness, band 9201 is shown in FIGS. 157, 158 & 159.

As seen in FIG. 157, band 9201 is introduced into the region betweenfacing end plates 2024 and 2025 while being initially retained in anarrowed configuration by engagement of sockets 9106 thereof (FIG. 148)by protrusions 9552 and 9554 of tool 9540 (FIG. 154C). A rearward end ofband 9201 is urged downwardly by engagement of aperture 9402 thereof bycylindrical pin 9566 of tool 9560 (FIG. 154D), which is mounted by quickconnector 874 (FIG. 26) onto vehicle 850.

The tool 9540 is then removed and protrusions 9552 and 9554 thereofautomatically disengage sockets 9106, leaving the band in an orientationshown in FIG. 158, with its rearward end still being retained in theregion between end plates 2024 and 2025 and urged downwardly byengagement of aperture 9402 thereof by cylindrical pin 9566 of tool 9560(FIG. 154D).

FIG. 159 illustrates the subsequent insertion of a inner band 9201,which is appropriately sized so as to fit concentrically inside theearlier inserted band 9201. A rearward end of this inner band 9201 isurged upwardly by engagement of an aperture 9402 thereof by acylindrical pin 9566 of another tool 9560 (FIG. 154D), which is mountedby quick connector 874 (FIG. 26) onto vehicle 850. The inner band 9201is preferably introduced generally in the same way as the outer band,using tool 9540.

FIG. 160 illustrates the arrangement of FIG. 159 following removal oftool 9540. It is seen that the forward end inner band 9201 is broadenedout into engagement with the outer band 9201. The rearward end of theinner band 9201 is retained in the region between end plates 2024 and2025 and urged upwardly by engagement of aperture 9402 thereof bycylindrical pin 9566 of tool 9560 (FIG. 154D).

It is appreciated that any suitable number and configuration of bandsmay be inserted for concentric positioning generally as describedhereinabove. Where the bands having interlocking portions, suitabletechniques are employed to produce desired interlocking thereof. A discreplacement band subassembly including one or more bands may thus beemployed in accordance with the present invention.

Reference is now made to FIGS. 161A & 161B, which are simplifiedpictorial illustrations of two stages in the insertion of any of theinflatable implants illustrated in FIGS. 146A-146C and FIGS. 147A-147Cbetween facing end plates of adjacent vertebrae following the stepsillustrated in FIGS. 157-159.

FIG. 161A illustrates introduction of inflatable implant 9000 (FIGS.146A & 147A) which is retained in a folded orientation inside retainingportion 9596 of tool 9590 (FIG. 154F), which is engaged by forceps tool9513 (FIG. 154B), while inflator tool 6818 (FIG. 106B) is operativelyengaged with implant 9000 for subsequent inflation thereof FIG. 161Billustrates the region between facing end plates 2024 and 2025 followinginflation of inflatable implant 9000 inside a plurality of bands 9201.

Reference is now made to FIGS. 162A & 162B, which are simplifiedpictorial illusions of two stages in the insertion of the inflatableimplant 9030 of FIGS. 146D & 147D together with a disc replacement bandsubassembly comprising either of the bands shown in FIGS. 149A & 149Ebetween facing end plates of adjacent vertebrae. It is appreciated thatthe structure and technique illustrated in FIGS. 162A & 162B is analternative to the separate insertion of the disc replacement bandsubassembly and subsequent insertion of the inflatable implant describedhereinabove in FIGS. 157-161B.

FIG. 162A illustrates insertion of a combination of inflatable implant9030 and disc replacement band 9300, wherein the inflatable implant 9030is located in a folded orientation inside recesses 9332 and 9334 formedin disc replacement band 9300. The technique of insertion of thiscombination may be similar in all relevant respects to that describedhereinabove with reference to FIGS. 157-160.

Following completion of the procedure illustrated in FIGS. 157-160 andinflation of the inflatable implant 9030, as by using tool 6818 (FIG.106B), the disc replacement implant assembly appears as indicated byreference numeral 9598 in FIG. 162B.

It is appreciated that a single band disc replacement band subassemblymay be employed alternatively in this embodiment. The use of a singleband disc replacement band subassembly for insertion together with aninflatable implant may have an advantage in that it enables the entiredisc replacement band assembly to be inserted at one time.

Reference is now made to FIGS. 163A, 163B, 163C, 163D, 163E, 163F &163G, which are partially sectional, partially pictorial illustrationsof the plurality of alternative disc replacement band assemblies ofFIGS. 146A-162 installed in situ between facing vertebrae in accordancewith a preferred embodiment of the present invention.

FIG. 163A illustrates a disc replacement band implant assembly 9600comprising an inflatable implant 9000 (FIGS. 146A & 147A) surrounded bya disc replacement band subassembly 9602 comprising typically two bands9201 (FIG. 149A). Inflatable implant 9000 is inflated so as to exertpressure in radially outward directions on subassembly 9602 so as tocause the entire disc replacement band implant assembly 9600 to betightly held together.

Protrusions 9202 and 9204 of bands 9201 (FIG. 149A) preferably seat inrecesses 2673 and 2674 which are formed by machining respective endplates 2024 and 2025 (FIG. 70D).

FIG. 163B illustrates a disc replacement band implant assembly 9610comprising an inflatable implant 9010 (FIGS. 146B & 147B) surrounded bya disc replacement band subassembly 9612 comprising typically two bands,including an inner band 9211 (FIG. 149B) and an outer band 9231 (FIG.149C). Inflatable implant 9010 is inflated so as to exert pressure inradially outward directions on subassembly 9612 so as to cause theentire disc replacement band implant assembly 9610 to be tightly heldtogether.

In particular this radial pressure causes the bands 9211 and 9231 tointerlock by means of undercut protrusion 9220 (FIG. 149B) and undercutsocket 9239 (FIG. 149C) and also causes band 9211 to be interlocked withinflatable implant 9010 by means of undercut protrusion 9012 (FIGS. 146B& 147B) and undercut socket 9222 (FIG. 149C).

Protrusions 9212 and 9214 of band 9211 (FIG. 149A) preferably seat inrecesses 2673 which are formed by machining respective end plates 2024and 2025 (FIG. 70D). Protrusions 9232 and 9234 of band 9231 (FIG. 149C)preferably seat in recesses 2674 which are formed by machiningrespective end plates 2024 and 2025 (FIG. 70D).

FIG. 163C illustrates a disc replacement band implant assembly 9620comprising an inflatable implant 9010 (FIGS. 146B & 147B) surrounded bya disc replacement band subassembly 9622 comprising typically two bands,including an inner band 9241 (FIG. 149D) and an outer band 9231 (FIG.149C). Inflatable implant 9010 is inflated so as to exert pressure inradially outward directions on subassembly 9622 so as to cause theentire disc replacement band implant assembly 9620 to be tightly heldtogether.

In particular this radial pressure causes band 9241 to be interlockedwith inflatable implant 9010 by means of undercut protrusion 9012 (FIGS.146B & 147B) and undercut socket 9250 (FIG. 149D).

Protrusions 9242 and 9244 of band 9241 (FIG. 149D) preferably seat inrecesses 2673 which are formed by machining respective end plates 2024and 2025 (FIG. 70D). Protrusions 9232 and 9234 of band 9231 (FIG. 149C)preferably seat in recesses 2674 which are formed by machiningrespective end plates 2024 and 2025 (FIG. 70D).

In accordance with a preferred embodiment of the present invention aflowable polymer is introduced, typically using tool 1319 (FIG. 29D)into a volume 9624 defined by peripheral undercut socket 9252 andsurface 9248 of band 9241 (FIG. 149D) and by peripheral undercut socket9239 and surface 9236 of band 9231 (FIG. 149C) and by adjacent surfacesof end plates 2024 and 2025. Once set, the flowable polymer locks bands9231 and 9241 together in flexible engagement.

FIG. 163D illustrates a disc replacement band implant assembly 9630comprising an inflatable implant 9020 (FIGS. 146C & 147C) surrounded bya disc replacement band subassembly 9632 comprising typically two bands,including an inner band 9427 (FIG. 153B) and an outer band 9407 (FIG.153A). Inflatable implant 9020 is inflated so as to exert pressure inradially outward directions on subassembly 9632 so as to cause theentire disc replacement band implant assembly 9630 to be tightly heldtogether.

In particular this radial pressure causes band 9427 to be interlockedwith inflatable implant 9020 by means of press fit engagement betweeninwardly facing edges 9436 and 9437 of band 9427 (FIG. 153D) andperipheral edges 9024 and 9026 of inflatable implant 9020 (FIGS. 146C &147C).

In addition this radial pressure causes band 9427 to be interlocked withband 9407 by means of press fit engagement between inwardly facing edges9414 and 9416 of band 9407 (FIG. 153A) and top and bottom corner edgerecesses 9430 and 9431 of band 9427 (FIG. 153B).

In accordance with a preferred embodiment of the present invention aflowable polymer is introduced, typically using tool 9570 (FIG. 154E)via valve 9404 (FIG. 152) and 9432 (FIG. 153B) into a volume 9633defined between adjacent bands 9427 and 9407 and into a volume 9634defined between band 9427 and peripheral protrusion 9022 of inflatableimplant 9020 (FIGS. 146C & 147C).

Preferably the flowable polymer is also introduced at the same time intorespective peripheral channels 2684 and 2686, each having a keystoneundercut cross-sectional configuration, which are formed in end plates2024 and 2025. Once set, the flowable polymer locks bands 9427 and 9207together in flexible engagement and also locks the bands to the endplates in flexible engagement.

The flowable polymer in volumes 9633 and 9634 is preferably joined byflowable polymer extending through apertures 9432. It is thusappreciated that the flowable polymer thus defines two interconnectedintermediate bands 9636 and 9638 formed in situ, joined by elements9639, which extend through apertures 9432.

It is noted that efficient introduction of flowable polymer into volumes9633 and 9634 and channels 2684 and 2686 is achieved using tool 9570(FIG. 154E) by generally simultaneously injecting the polymer via valve9404 and suctioning the volumes until the polymer fully fills thevolumes and the channels.

FIG. 163E illustrates a disc replacement band implant assembly 9640comprising an inflatable implant 9020 (FIGS. 146C & 147C) surrounded bya disc replacement band subassembly 9642 comprising typically a singleband 9407 (FIG. 153A). Inflatable implant 9020 is inflated so as toexert pressure in radially outward directions on subassembly 9642 so asto cause the entire disc replacement band implant assembly 9630 to betightly held together.

In this embodiment, between band 9407 and inflatable implant 9020, thereis provided an intermediate band 9644 which is formed in situ from aflowable polymer, injected in a manner described hereinbelow.

In accordance with a preferred embodiment of the present invention theflowable polymer is introduced, typically using tool 9570 (FIG. 154E)via valve 9404 (FIG. 152) and 9432 (FIG. 153B) into a volume definedbetween inner surfaces of band 9407 and peripheral edges 9024 and 9026of inflatable implant 9020 (FIGS. 146C & 147C). Preferably the flowablepolymer is also introduced at the same time into respective peripheralchannels 2684 and 2686, each having a keystone undercut cross-sectionalconfiguration, which are formed in end plates 2024 and 2025.

Once set, the flowable polymer locks band 9407 to the end plates inflexible engagement. The flowable polymer in intermediate band 9644 alsoretains inflatable implant 9020 in position and retains band 9407 indesired surrounding engagement therewith.

FIG. 163F illustrates a disc replacement band implant assembly 9650comprising implant 9050 (FIGS. 146F & 147F) together with a discreplacement band subassembly 9652 comprising typically two hollow bands9261 (FIG. 149E). Id this embodiment, body material 9654 from thenucleus pulposus, earlier taken from the patient or from any othersuitable source and suitably processed, is reintroduced via implant9050, under pressure to a volume intermediate adjacent end plates 2024and 2025 interior of subassembly 9652. The pressure exerted by material9654 exerts pressure in radially outward directions on subassembly 9652so as to cause the entire disc replacement band implant assembly 9650 tobe tightly held together.

Protrusions 9263 and 9264 of bands 9261 (FIG. 149E) preferably seat inrecesses 2673 and 2674 which are formed by machining respective endplates 2024 and 2025 (FIG. 70D).

It is appreciated that any other suitable bands may be employed insteadof or in addition to bands 9261.

FIG. 163G illustrates a disc replacement band implant assembly 9660comprising an inflatable implant 9030 (FIGS. 146D & 147D) surrounded bya disc replacement band subassembly 9662 comprising typically two bands,including an inner band 9300 (FIGS. 150 & 151) and an outer band 9201(FIG. 149A).

Assembly 9660 preferably corresponds to the embodiment describedhereinabove with reference to FIGS. 162A & 162B wherein the inflatableimplant and the inner band of the disc replacement band subassembly areinserted together. Alternatively a single band disc replacement bandsubassembly may be employed.

Inflatable implant 9030 is inflated so as to exert pressure in radiallyoutward directions on subassembly 9662 so as to cause the entire discreplacement band implant assembly 9660 to be tightly held together.

In particular this radial pressure causes the bands 9201 and 9300 to betightly engaged together. The radial pressure also causes band 9300 tobe interlocked with the inflatable implant 9030. Specificallyprotrusions 9032 and 9034 are seated in respective recesses 9332 and9334 in band 9300.

Protrusions 9362 and 9364 of band 9300 (FIGS. 150 & 151) preferably seatin recesses 2673 which are formed by machining respective end plates2024 and 2025 (FIG. 70D). Protrusions 9202 and 9204 of band 9201 (FIG.149A) preferably seat in recesses 2674 which are formed by machiningrespective end plates 2024 and 2025 (FIG. 70D).

It is further appreciated that various features described hereinabovewith reference to FIGS. 163A-163G may be combined in variouscombinations and subcombinations as suitable for a particular medicalapplication.

FIGS. 164A and 164B illustrate adjacent vertebra having therebetween areplacement disc of the type provided in accordance with an embodimentof the present invention described above and illustrated in FIGS.99A-98L in respective straight and flexed operative orientations,corresponding to a section taken along lines A-A in FIG. 4C.

FIGS. 165A and 165B illustrate adjacent vertebra having therebetween areplacement disc of the type provided in accordance with anotherembodiment of the present invention described hereinabove andillustrated in FIGS. 130A-130L in respective straight and flexedoperative orientations, corresponding to a section taken along lines A-Ain FIG. 4C.

FIGS. 166A and 166B are simplified sectional illustrations of adjacentvertebra having therebetween a replacement disc of the type provided inaccordance with still another embodiment of the present inventiondescribed hereinabove and illustrated in FIG. 145 in respective straightand flexed operative orientations, corresponding to a section takenalong lines A-A in FIG. 4C.

FIGS. 167A and 167B are simplified sectional illustrations of adjacentvertebra having therebetween a replacement disc of the type provided inaccordance with yet another embodiment of the present inventiondescribed hereinabove and illustrated in FIGS. 163A-163G in respectivestraight and flexed operative orientations, corresponding to a sectiontaken along lines A-A in FIG. 4C.

It is appreciated that the disc replacement assemblies of the presentinvention are multi-functional in that they provided not only a widerange of articulation of the vertebrae but also shock absorbing andrequired load bearing.

Reference is now made to FIGS. 168-174B, which illustrate techniques forperforming spinal fusion in accordance with a preferred embodiment ofthe present invention.

FIGS. 168 and 169 are simplified pictorial illustrations of two phasesof end plate machining carried out as part of a technique for spinalfusion in accordance with a preferred embodiment of the presentinvention. An initial milling stage, shown in FIG. 68, preferablyemploys surgical vehicle 700 (FIGS. 23A & 23B), hand 900 (FIG. 27), tool1301 (FIG. 29B) and milling head 1032 (FIG. 28D) for machining an endplate 2025 to provide a generally flat surface 9700.

FIG. 169 shows that further in the course of the milling stage, the topsurface 9700 of end plate 2025 is further machined, preferably usingsurgical vehicle 700 (FIGS. 23A & 23B), hand 900 (FIG. 27), tool 1300(FIG. 29A) and milling head 1002 (FIG. 28A), to provide substantiallystraight channels 9702 and 9704 extending from one edge of the end plate2025 preferably to a location adjacent an opposite edge thereof.

FIG. 170A illustrates the insertion and placement of a bone graft 9706on top surface 9700. It is noted that the bone graft 9706 is preferablyformed to have a bottom facing protrusion 9708, matching channel 9704formed in top surface 9700. Preferably, the bone graft 9706 has recesses9709 at upper and lower surfaces thereof to accommodate the fingers of aforceps tool 1313 (FIG. 29C).

The step of FIG. 170A is preferably carried out using, in addition totool 1313, surgical vehicle 800 (FIGS. 25A & 25B) and hand 900 (FIG.27). The bone graft 9706 is preferably slid into position untilprotrusion 9708 engages the end of channel 9704.

FIG. 170B illustrates the insertion and placement of a bone graft 9710on top surface 9700. It is noted that the bone graft 9710 is preferablyformed to have a bottom facing protrusion 9711, matching channel 9702formed in top surface 9700. Preferably, the bone graft 9710 has recesses9712 at upper and lower surfaces thereof to accommodate the fingers offorceps tool 1313 (FIG. 29C).

The step of FIG. 170B is preferably carried out using, in addition totool 1313, surgical vehicle 800 (FIGS. 25A & 25B) and hand 900 (FIG.27). The bone graft 9710 is preferably slid into position untilprotrusion 9711 engages the end of channel 9702.

FIG. 170C illustrates the insertion and placement of an apertured bonegraft enclosure 9720 having recesses 9722 at upper and lower surfacesthereof to accommodate the fingers of forceps tool 1313 (FIG. 29C) andapertures 9724 at top and bottom surface thereof. The bone graftenclosure 9720, which may be formed of metal or of any other suitablematerial, such as ceramic, preferably encloses a bone graft 9726.

The step of FIG. 170C is preferably carried out using, in addition totool 1313, surgical vehicle 800 (FIGS. 25A & 25B) and hand 900 (FIG.27).

FIG. 170D illustrates the arrangement of bone graphs following insertionand placement steps shown in FIGS. 170A-170D. It is appreciated thatgrowth of the bone grafts onto the adjacent bone of the end plates willproduce desired spinal fusion. The apertured enclosure 9720 is providedto enhance mechanical strength of the implants, while allowing bonegrowth therethrough.

Reference is now made to FIG. 171, which is a simplified pictorialillustration of a bone graft segment 9730 enclosed within a fiber sleeve9732 in accordance with an embodiment of the present invention. Thefiber sleeve is preferably formed of DYNEEMA® fiber and is provided toproduce a honeycomb structure, which improves the strength of theresulting fused grafts, particularly in their resistance to bucklingforces.

FIG. 172 is a simplified pictorial illusion of a bone graft assemblycomprising a plurality of segments, indicated by reference numerals9741, 9742, 9743, 9744 and 9745, each enclosed within a fiber sleeve,which are together enclosed within a fiber assembly enclosure 9746 inaccordance with an embodiment of the present invention. Both the fibersleeve and the fiber assembly enclosure 9746 are preferably woven fromDYNEEMA®.

FIG. 173 is a simplified pictorial illustration, corresponding to thatof FIG. 170D and employing bone graft assemblies 9750, 9752 and 9754which may be similar in construction to the bone graft assembly of FIG.171.

FIGS. 174A and 174B are simplified sectional illustrations of adjacentvertebra having therebetween bone graft assemblies respectively of thetypes shown in FIGS. 170D and 173 provided in accordance with yetanother embodiment of the present invention. FIG. 174A, which is takenalong lines CLXXIVA-CLXXIVA in FIG. 170D, shows the structure of theimplant described hereinabove with reference to FIGS. 170A-170D.

It is appreciated that although insertion of the bone grafts onto oneend plate has been described hereinabove, the bone grafts may beattached to a facing end plate in the same manner. Any suitable adhesiveor mechanism may be used for retaining the bone grafts in place betweenthe two end plates until fusion occurs.

It is appreciated that additional surgical procedures are involved incompleting the spinal fusion procedure. These may be carried out usingthe equipment and techniques described hereinabove.

It is noted that although the foregoing description relates exclusivelyto spinal surgery, the present invention is not limited to spinalsurgery but is applicable to any other suitable type of medicaltreatment.

It will be appreciated by persons skilled in the art that the presentinvention is not limited by what has been described hereinabove. Ratherthe scope of the present invention includes both combinations andsubcombinations of the various features described hereinabove as well asmodifications and variations thereof as would occur to a person ofordinary skill in the art upon reading the foregoing description andwhich are not in the prior art.

1. A method of performing spinal surgery on a patient comprising:imaging a spinal region of the patient; building up a three dimensionalimage file of the spinal region of the patient; storing the image file;utilizing the image file for planning and carrying out computercontrolled spinal surgery on the patient, said computer controlledspinal surgery on the patient comprising: determining a navigation pathof a first cannula subassembly in three spatial dimensions and overtime; determining an anchoring location for said first cannulasubassembly, said anchoring location being at a disc located within saidspinal region; and anchoring said first cannula subassembly at saidanchoring location by providing rotational threaded engagement of ananchoring screw of said first cannula subassembly at said disc.
 2. Amethod of performing spinal surgery on a patient according to claim 1also comprising: planning and visualizing a computer controlled surgicalapproach path, in order to maximize avoidance of vital organs, nervesand blood vessels.
 3. A method of performing spinal surgery on a patientaccording to claim 1 wherein said utilizing the image file for planningand carrying out computer controlled spinal surgery on the patientemploys patient data stored in a computer memory as well as imaging dataderived from earlier patient imaging and reference medical data, saidreference medical data including medical imaging information currentlyavailable on computer networks.
 4. A method of performing spinal surgeryon a patient according to claim 1 wherein said imaging step comprisesdetermining a desired patient orientation for pre-operative imaging andperforming computer simulated imaging based on the desired patientorientation.
 5. A method of performing spinal surgery on a patientaccording to claim 1 wherein patient imaging is supplemented in a regionof interest with medical reference data and composite images areprovided, characterized in that patient imaging data is clearlydistinguished from overlaid reference data.
 6. A method of performingspinal surgery on a patient according to claim 1, further comprising:providing a second cannula subassembly and a third cannula subassembly;determining timing of insertion of third cannula subassembly over firstand second cannula subassemblies; and determining an intended anchoringlocation for said third cannula subassembly, said intended anchoringlocation for said third cannula subassembly being on a vertebra of saidpatient.
 7. A method of performing spinal surgery on a patient accordingto claim 6 wherein the utilizing the image file for planning andcarrying out computer controlled spinal surgery on the patientcomprises: determining timing of removal from the body of the patient ofsaid first cannula subassembly and said second cannula subassembly.
 8. Amethod of performing spinal surgery on a patient according to claim 1wherein the utilizing the image file for planning and carrying outcomputer controlled spinal surgery on the patient comprises: restorationof end plates of vertebrae utilizing surgical vehicles and millingtools.
 9. A method of performing spinal surgery on a patient accordingto claim 8 wherein said restoration comprises insertion of a top surfaceplate following suitable machining of the top surface of an end plate.10. A method of performing spinal surgery on a patint according to claim8 wherein said restoration comprises providing treatment for a buckledportion of the end plate of a vertebra by milling a seat for securelyreceiving a bone graft and inserting a bone graft at said seat withprecise dimensions corresponding to those of said seat such that aportion of said bone graft protrudes from a top surface of said endplate. and folloxx ed by milling of said bone raft protrusion up to asurface of said end plate canceling said buckled geometry of said endplate.
 11. A method of performing spinal surgery on a patient accordingto claim 8 wherein said restoration comprises providing treatment forscoliosis by milling a seat and a channel for securely receiving a bonegraft and inserting a bone graft at said seat and said channel withprecise dimensions corresponding to those of said seat and said channelsuch that a portion of said bone graft protrudes from a top surface ofsaid end plate, followed by milling of said bone graft protrusion up toa surface canceling the scoliosis inclination.
 12. A method ofperforming spinal surgery on a patient according to claim 1 wherein saidutilizing the image file for planning and carrying out computercontrolled spinal surgery on the patient includes an initial millingstage defining a recess for an inflatable pillow.
 13. A method ofperforming spinal surgery on a patient according to claim 12 wherein theinflatable pillow is a generally “bean shaped” inflatable pillow.
 14. Amethod of performing spinal surgery on a patient according to claim 12and also comprising defining at least one channel in said end plate. 15.A method of performing spinal surgery on a patient according to claim 12and also comprising planning insertion of an inflatable implant in arecess formed in at least one end plate.
 16. A method of performingspinal surgery on a patient according to claim 1 and also comprisinginsertion of an inflatable implant between end plates of adjacentvertebra by employing tools including an inflation tool in associationwith a surgical vehicle.
 17. A method of performing spinal surgery on apatient according to claim 16 and also comprising insertion of a flatdisc replacement coil surrounding the inflatable implant.
 18. A methodof performing spinal surgery on a patient according to claim 17 whereinsaid disc replacement implant compriscs an upstanding disc replacementcoil.
 19. A method of performing spinal surgery on a patient accordingto claim 1 wherein said utilizing the image file for planning andcarrying out computer controlled spinal surgery on the patient comprisescarrying out a simulated operation on a computer in an off-line manner.20. A method of performing spinal surgery on a patient according toclaim 19 wherein the step of carrying out a simulated operation employsstored patient image data and is linked to an intended configuration ofan implant and its operating environment.
 21. A method of performingspinal surgery on a patient according to claim 19 wherein during thestep of carrying out a simulated operation, a at least one aspect of aplanned operation is modified.
 22. A method of performing spinal surgeryon a patient according to claim 19 also including applying computeranalysis to the simulated operation.
 23. A method of performing spinalsurgery on a patient according to claim 22 also including providingcomputer generated comments and warnings to an operator based on saidcomputer analysis.
 24. A method of performing spinal surgery on apatient according to claim 1 wherein said step of utilizing the imagefile for planning and carrying out computer controlled spinal surgery onthe patient, comprises the steps of: extracting a cannula entry positionfor said first cannula subassembly from a final real time startingoperation plan; positioning the patient as required; and inserting thefirst cannula subassembly into the patient in accordance with said finalreal time starting operation plan as modified interactively in realtime.
 25. A method of performing spinal surgery on a patient accordingto claim 24 wherein said step of inserting the first cannula subassemblyinto the patient comprises the steps of: initiating penetration of thefirst cannula subassembly into the patient; and using the final realtime starting operation plan as modified interactively in real time bycausing a desired sequence of coordinated movements of the first cannulasubassembly, said coordinated movements including at least one of linearforward motion of the first cannula subassembly, rotation of the firstcannula subassembly and curvature control of the first cannulasubassembly.
 26. A method of performing spinal surgery on a patientaccording to claim 25 wherein said step of causing a desired sequence ofcoordinated movements of the first cannula subassembly is effected byprovision of synchronized instructions to a controller for operation ofat least one motor and at least one piston of a steering subassembly.27. A method of performing spinal surgery on a patient according toclaim 25 wherein said step of causing a desired sequence of coordinatedmovements of the first cannula subassembly is effected by employingreal-time imaging.
 28. A method of performing spinal surgery on apatient according to claim 26 wherein the provision of synchronizedinstructions is terminated upon anchoring of said first cannulasubassembly at said anchoring location at said disc.
 29. A method ofperforming spinal surgery on a patient according to claim 28 whereinsaid anchoring of said first cannula subassembly with a disc isevidenced at least partially by real-time imaging.
 30. A method ofperforming spinal surgery on a patient according to claim 1 and alsocompnsing sliding a second cannula subassembly over the said firstcannula subassernbly.
 31. A method of performing spinal surgery on apatient according to claim 30 wherein said sliding comprises: insertingsaid second cannula subassembly along the outside of said first cannulasubassembly,; providing a desired sequence of movements of the saidsecond cannula subassembly, derived from the final real time startingoperation plan as modified interactively in real time; providing forwardmotion of the second cannula subassembly, using a motor in response toinputs supplied thereto by a controller; and when said second cannulasubassembly reaches said disc, turning off said motor by saidcontroller.
 32. A method of performing spinal surgery on a patientaccording to claim 31 and also comprising sliding a third cannulasubassembly over said second cannula subassembly.
 33. A method ofperforming spinal surgery on a patient according to claim 32 whereinsaid sliding said third cannula subassembly takes place in accordancewith said final real time operation plan as modified interactively inreal time.
 34. A method of performing spinal surgery on a patientaccording to claim 32 wherein said sliding said third cannulasubassembly comprises: inserting said third cannula subassembly alongthe outside of said second cannula subassembly; providing a desiresequence of movements of said third cannula subassembly, which sequenceis derived from the final real time starting operation plan as modifiedinteractively in real time; providing forward motion of the thirdcannula subassembly, using a motor in response to inputs suppliedthereto by a controller; and turning off said motor by said controllerwhen said third cannula subassembly reaches at least one vertebra.
 35. Amethod of performing spinal surgery on a patient according to claim 1and also comprising the step of vertebra machining.
 36. A method ofperforming spinal surgery on a patient according to claim 35 wherein thestep of vertebra machining includes an initial milling stage defining arecess for an implant.
 37. A method of performing spinal surgery on apatient according to claim 36, wherein said initial milling stagedefines a recess for an inflatable pillow as well as a network ofchannels including a plurality of generally radially directed channelsand a peripheral channel.
 38. A method of performing spinal surgery on apatient according to claim 37, wherein said inflatable pillow isgenerally “bean shaped”.
 39. A method of performing spinal surgery on apatient according to claim 37 wherein in said initial milling stage, agenerally central region of a top surface of an end plate is milled toprovide a generally smooth milled surface having a recess formedgenerally at the center thereof.
 40. A method of performing spinalsurgery on a patient according to claim 1 and also comprising the stepof disc implantation.
 41. A method of performing spinal surgery on apatient according to claim 1 and also comprising the step of vertebraend plate reconstruction.
 42. A method of performong spinal surgery on apatient according to claim 41 wherein said step of vertebra end platereconstruction includes the steps of employing a surgical vehicle and apair of forceps tools to insert, position and spread out a reinforcingfabric over a machined surface of an end plate.
 43. A method ofperforming spinal surgery on a patient according to claim 42 whereinsaid reinforcing fabric is impregnated with an adhesive which isactivated in situ.
 44. A method of performing spinal surgery on apatient according to claim 41 wherein said reinforcing fabric is adheredusing a fluid adhesive.
 45. A method of performing spinal surgery on apatient according to claim 41 wherein said step of vertebra end platereconstruction includes the steps of machining of a top surface of anend plate and subsequent insertion and placement thereover of at leastone top surface plate.
 46. A method of performing spinal surgery on apatient according to claim 45 wherein said at least one top surfaceplate is impregnated with an adhesive which is activated in situ.
 47. Amethod of perfonning spinal surgery on a patient according to claim 45,wherein said at least one top surface plate is adhered using a fluidadhesive.
 48. A method of performing spinal surgery on a patientaccording to claim 45 wherein said machining of a top surface of an endplate comprises using a surgical vehicle and a milling head to provide agenerally smooth milled surface having a recess formed generally at thecenter thereof.
 49. A method of performing spinal surgery on a patientaccording to claim 48 wherein said step of machining of a top surface ofan end plate also comprises using a surgical vehicle and a milling headto provide at least one peripheral channel surrounding said recess. 50.A method of performing spinal surgery on a patient according to claim 49wherein said step of machining of a top surface of an end plate alsocomprises using a surgical vehicle and a milling head to provide atleast one nearly peripheral channel, having ends which extend to an edgeof the end plate.
 51. A method of performing spinal surgery on a patientaccording to claim 49 wherein said at least one peripheral channelsurrounding said recess has a generally semicircular cross-sectionalconfiguration.
 52. A method of performing spinal surgery on a patientaccording to claim 49 wherein said at least one peripheral channelsurrounding said recess has a keystone undercut cross-sectionalconfiguration.
 53. A method of performing spinal surgery on a patientaccording to claim 45 wherein said machining of a top surface of an endplate comprises using a surgical vehicle and a milling head to provide agenerally smooth milled surface having a channel and a recess formedgenerally at the center thereof.
 54. A method of performing spinalsurgery on a patient according to claim 45 wherein said machining of atop surface of an end plate comprises using a surgical vehicle and amilling head to provide a generally smooth milled surface having achannel and a generally oval recess formed generally at the centerthereof as an extension of said channel.